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 |
|---|---|---|---|---|
| E Bridgewater, MA | $67.56 | $61.59 – $100.73 | 354 | 2 |
| Philmont, NY | $26.74 | $26.74 – $26.74 | 354 | 1 |
| New Preston Marble Dale, CT | $1.39 | $1.39 – $1.39 | 352 | 1 |
| Greybull, WY | $37.74 | $37.74 – $37.74 | 351 | 1 |
| Cedarcreek, MO | $56.34 | $56.34 – $56.34 | 351 | 1 |
| Reardan, WA | $29.14 | $29.14 – $29.14 | 349 | 1 |
| Gambier, OH | $41.55 | $41.55 – $41.55 | 349 | 1 |
| Agana Heights, GU | $29.34 | $29.34 – $29.34 | 349 | 1 |
| Manahaukin, NJ | $75.47 | $75.47 – $75.47 | 348 | 1 |
| Malta, IL | $0.00 | $0.00 – $0.00 | 348 | 1 |
| Rio Linda, CA | $0.41 | $0.41 – $0.41 | 347 | 1 |
| Allouez, WI | $67.50 | $67.50 – $67.50 | 347 | 1 |
| Oka Tamuning, GU | $87.04 | $58.26 – $94.89 | 345 | 2 |
| Latimer, IA | $0.00 | $0.00 – $0.00 | 345 | 1 |
| Noth Ogden, UT | $40.55 | $40.55 – $40.55 | 344 | 1 |
| Montrose, NY | $61.07 | $61.07 – $61.07 | 343 | 1 |
| Waverly, NE | $57.65 | $57.65 – $57.65 | 343 | 1 |
| Copper Hill, VA | $80.37 | $80.37 – $80.37 | 343 | 1 |
| Philadelhia, PA | $53.07 | $53.07 – $53.07 | 342 | 1 |
| Dayton, IA | $19.35 | $0.00 – $29.81 | 342 | 2 |
| Nicasio, CA | $30.53 | $30.53 – $30.53 | 342 | 1 |
| Takoma Pk, MD | $2.89 | $2.89 – $2.89 | 341 | 1 |
| Weidman, MI | $54.78 | $54.78 – $54.78 | 341 | 1 |
| Beverly, NJ | $42.75 | $42.75 – $42.75 | 341 | 1 |
| Dania, FL | $16.08 | $0.00 – $37.12 | 341 | 3 |
| Marmet, WV | $1.49 | $1.49 – $1.49 | 340 | 1 |
| Keenesberg, CO | $63.88 | $63.88 – $63.88 | 340 | 1 |
| East Douglas, MA | $64.32 | $64.32 – $64.32 | 339 | 1 |
| Ranchester, WY | $45.54 | $45.54 – $45.54 | 339 | 1 |
| Seligman, AZ | $0.00 | $0.00 – $0.00 | 339 | 1 |
| Talbotton, GA | $121.08 | $121.08 – $121.08 | 339 | 1 |
| Edison, GA | $27.53 | $27.53 – $27.53 | 338 | 1 |
| Matamoras, PA | $52.76 | $52.76 – $52.76 | 338 | 1 |
| Ashland, MA | $0.80 | $0.80 – $0.80 | 338 | 1 |
| Emily, MN | $42.16 | $41.13 – $44.98 | 337 | 2 |
| Elizabethtown, IL | $0.00 | $0.00 – $0.00 | 337 | 1 |
| N Babylon, NY | $24.52 | $24.52 – $24.52 | 337 | 1 |
| Curtis, NE | $104.10 | $97.83 – $145.86 | 337 | 2 |
| Ireton, IA | $30.89 | $30.43 – $35.67 | 336 | 2 |
| Gardners, PA | $1.98 | $1.98 – $1.98 | 335 | 1 |
| Canyon Lake, CA | $24.18 | $24.18 – $24.18 | 334 | 1 |
| Norco, LA | $47.81 | $0.00 – $53.95 | 334 | 2 |
| Hartley, IA | $0.49 | $0.49 – $0.49 | 334 | 1 |
| Birnamwood, WI | $58.22 | $58.22 – $58.22 | 334 | 1 |
| Roadhouse, IL | $0.35 | $0.35 – $0.35 | 333 | 1 |
| Birchwood, TN | $217.02 | $39.78 – $962.00 | 333 | 2 |
| Springville, PA | $0.00 | $0.00 – $0.00 | 333 | 1 |
| Otisville, NY | $52.85 | $52.85 – $52.85 | 333 | 1 |
| Rosendale, NY | $92.39 | $78.63 – $110.21 | 333 | 2 |
| Chama, NM | $32.95 | $32.95 – $32.95 | 332 | 1 |
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.