Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Cascade, MD | $58.20 | $54.04 – $117.43 | 396 | 2 |
| Barnstable, MA | $30.23 | $30.23 – $30.23 | 396 | 1 |
| Quartz Hill, CA | $15.18 | $0.00 – $23.65 | 394 | 2 |
| W Des Moines, IA | $42.58 | $42.58 – $42.58 | 394 | 1 |
| Mount Rainer, MD | $13.69 | $13.69 – $13.69 | 394 | 1 |
| Ashley, IL | $30.30 | $30.30 – $30.30 | 393 | 1 |
| Duncan Falls, OH | $41.76 | $41.76 – $41.76 | 393 | 1 |
| Peshawbestown, MI | $445.32 | $445.32 – $445.32 | 393 | 1 |
| Lagunitas, CA | $0.00 | $0.00 – $0.00 | 392 | 1 |
| Malverne, NY | $80.62 | $64.42 – $103.15 | 392 | 2 |
| Galway, NY | $41.66 | $27.78 – $67.49 | 391 | 4 |
| South Palm Beach, FL | $106.56 | $106.56 – $106.56 | 391 | 1 |
| Piermont, NY | $91.99 | $91.99 – $91.99 | 391 | 1 |
| Howard Lake, MN | $40.79 | $23.55 – $49.51 | 390 | 2 |
| Mendon, OH | $35.95 | $35.95 – $35.95 | 388 | 1 |
| E Town, KY | $25.62 | $25.62 – $25.62 | 388 | 1 |
| Pine Apple, AL | $37.10 | $37.10 – $37.10 | 388 | 1 |
| Concord, AR | $12.70 | $12.40 – $20.56 | 388 | 2 |
| Colo, IA | $33.11 | $33.11 – $33.11 | 387 | 1 |
| Saint Louis, MI | $50.46 | $31.30 – $52.85 | 387 | 2 |
| Paton, IA | $32.48 | $32.48 – $32.48 | 387 | 1 |
| Auberry, CA | $2.33 | $2.33 – $2.33 | 387 | 1 |
| Lynnville, IA | $155.51 | $155.51 – $155.51 | 386 | 1 |
| Electra, TX | $17.64 | $2.43 – $29.09 | 386 | 3 |
| Owen, WI | $32.21 | $10.94 – $59.13 | 386 | 5 |
| Ft. Eustis, VA | $79.70 | $79.70 – $79.70 | 385 | 1 |
| Manhattan, IL | $57.96 | $46.77 – $78.41 | 384 | 4 |
| Uintah, UT | $38.72 | $38.72 – $38.72 | 384 | 1 |
| New Milford, PA | $4.02 | $0.00 – $28.52 | 383 | 2 |
| Gwinner, ND | $55.61 | $55.61 – $55.61 | 383 | 1 |
| Downsville, NY | $67.22 | $60.30 – $69.54 | 383 | 2 |
| Vlenna, VA | $64.31 | $64.31 – $64.31 | 382 | 1 |
| Montezuma, KS | $57.94 | $27.23 – $69.59 | 382 | 2 |
| Rockford, TN | $70.42 | $70.42 – $70.42 | 382 | 1 |
| Leroy, NY | $88.42 | $88.42 – $88.42 | 381 | 1 |
| Lead, SD | $68.56 | $68.56 – $68.56 | 381 | 1 |
| Shprock, NM | $562.60 | $562.60 – $562.60 | 381 | 1 |
| Fordyce, AR | $33.69 | $22.01 – $41.18 | 381 | 2 |
| Maud, TX | $8.87 | $8.87 – $8.87 | 381 | 1 |
| Colver, PA | $35.80 | $35.80 – $35.80 | 380 | 1 |
| Fancy Gap, VA | $19.56 | $13.86 – $24.59 | 380 | 2 |
| Honomu, HI | $83.76 | $83.76 – $83.76 | 380 | 1 |
| Colt, AR | $45.73 | $45.73 – $45.73 | 379 | 1 |
| Manvel, TX | $18.43 | $0.99 – $27.67 | 378 | 2 |
| Woodford, VA | $75.77 | $75.77 – $75.77 | 377 | 1 |
| Atkinson, NC | $53.08 | $53.08 – $53.08 | 377 | 1 |
| Salisbury, VT | $64.24 | $64.24 – $64.24 | 376 | 1 |
| Scott City, MO | $48.85 | $37.16 – $49.40 | 376 | 2 |
| Elizabeth, CO | $50.90 | $50.90 – $50.90 | 375 | 1 |
| Lawrence Township, NJ | $58.05 | $1.18 – $72.98 | 375 | 5 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.