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 |
|---|---|---|---|---|
| Worcester, VT | $68.27 | $68.27 – $68.27 | 332 | 1 |
| S Pittsburg, TN | $14.48 | $14.48 – $14.48 | 332 | 1 |
| Montverde, FL | $19.25 | $19.25 – $19.25 | 332 | 1 |
| Keelser Afb, MS | $37.49 | $37.49 – $37.49 | 331 | 1 |
| Shenandoah, PA | $0.76 | $0.76 – $0.76 | 331 | 1 |
| Woonsocket, SD | $169.18 | $169.18 – $169.18 | 330 | 1 |
| Young Harris, GA | $43.99 | $8.38 – $62.12 | 329 | 2 |
| Comfort, WV | $0.95 | $0.95 – $0.95 | 329 | 1 |
| Capon Bridge, WV | $57.84 | $57.84 – $57.84 | 329 | 1 |
| Dupont, PA | $24.51 | $22.51 – $27.80 | 328 | 2 |
| Dilley, TX | $7.48 | $0.15 – $28.63 | 328 | 4 |
| Littlerock, CA | $0.00 | $0.00 – $0.00 | 328 | 1 |
| Ghent, WV | $15.26 | $15.26 – $15.26 | 327 | 1 |
| Trenton, NC | $32.29 | $32.29 – $32.29 | 327 | 1 |
| South Paris, ME | $29.82 | $29.82 – $29.82 | 327 | 1 |
| Clifton Forge, VA | $66.13 | $51.74 – $69.84 | 327 | 2 |
| Mt. Dora, FL | $119.46 | $119.46 – $119.46 | 327 | 1 |
| Tahoe City, CA | $40.22 | $34.96 – $52.28 | 326 | 2 |
| Auburndale, MA | $15.48 | $10.47 – $25.88 | 326 | 2 |
| Mexico, ME | $37.85 | $37.85 – $37.85 | 326 | 1 |
| Wakfield, VA | $57.87 | $57.87 – $57.87 | 324 | 1 |
| Grand Canyon, AZ | $17.62 | $0.00 – $85.93 | 324 | 3 |
| Alvord, TX | $0.19 | $0.00 – $0.21 | 323 | 2 |
| Fort Novosel, AL | $34.90 | $34.90 – $34.90 | 323 | 1 |
| Chicora, PA | $26.50 | $26.50 – $26.50 | 323 | 1 |
| Mingo Junction, OH | $39.21 | $39.21 – $39.21 | 323 | 1 |
| Blue Rock, OH | $47.11 | $47.11 – $47.11 | 322 | 1 |
| East Weymouth, MA | $23.13 | $4.10 – $33.46 | 322 | 3 |
| Newton Center, MA | $63.62 | $63.62 – $63.62 | 321 | 1 |
| Warmisnter, PA | $47.49 | $47.49 – $47.49 | 320 | 1 |
| Inlet Beach, FL | $14.49 | $14.41 – $15.78 | 320 | 2 |
| Avalon, PA | $60.39 | $60.39 – $60.39 | 320 | 1 |
| Plantaion, FL | $28.91 | $28.91 – $28.91 | 320 | 1 |
| Bullard, TX | $37.22 | $4.55 – $61.07 | 320 | 5 |
| Central Lake, MI | $17.89 | $17.89 – $17.89 | 320 | 1 |
| Lyons, NE | $77.58 | $77.58 – $77.58 | 320 | 1 |
| Hockley, TX | $22.64 | $22.64 – $22.64 | 319 | 1 |
| Hollins, VA | $56.05 | $55.88 – $57.87 | 319 | 2 |
| Brocton, NY | $48.94 | $48.94 – $48.94 | 319 | 1 |
| Ballentine, SC | $36.59 | $13.70 – $48.80 | 319 | 3 |
| New Plymouth, ID | $2.31 | $2.31 – $2.31 | 318 | 1 |
| Palisade, CO | $62.70 | $62.70 – $62.70 | 318 | 1 |
| Kirbyville, TX | $11.71 | $10.17 – $14.18 | 317 | 2 |
| North Field, NJ | $11.70 | $11.70 – $11.70 | 317 | 1 |
| Bel Camp, MD | $113.71 | $113.71 – $113.71 | 317 | 1 |
| Miami, AZ | $43.51 | $43.51 – $43.51 | 317 | 1 |
| Glencoe, IL | $237.08 | $43.48 – $313.83 | 317 | 2 |
| Edwards, MS | $15.98 | $15.98 – $15.98 | 316 | 1 |
| Sharpsville, PA | $52.71 | $52.71 – $52.71 | 316 | 1 |
| Empire, CA | $2.66 | $0.00 – $2.78 | 315 | 2 |
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.