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 |
|---|---|---|---|---|
| Val Verde, CA | $6.29 | $2.77 – $7.58 | 301 | 2 |
| Seabrook, TX | $18.41 | $2.88 – $28.93 | 301 | 4 |
| Westfield, NC | $0.12 | $0.12 – $0.12 | 300 | 1 |
| Rolling Mdws, IL | $12.31 | $12.31 – $12.31 | 300 | 1 |
| Dardenne Prairie, MO | $65.29 | $0.00 – $68.02 | 300 | 2 |
| Tuckanoe, NY | $99.80 | $99.80 – $99.80 | 299 | 1 |
| Tilton, NH | $37.66 | $30.13 – $44.55 | 299 | 3 |
| Saint Regis Falls, NY | $60.23 | $60.23 – $60.23 | 298 | 1 |
| Sorrento, LA | $10.30 | $10.30 – $10.30 | 298 | 1 |
| Perryille, MO | $78.16 | $78.16 – $78.16 | 297 | 1 |
| Brownstown, MI | $44.82 | $44.82 – $44.82 | 297 | 1 |
| San Monica, CA | $49.43 | $49.43 – $49.43 | 297 | 1 |
| Altaville, CA | $29.63 | $29.63 – $29.63 | 297 | 1 |
| Dummerston, VT | $169.34 | $169.34 – $169.34 | 296 | 1 |
| Fox Lake, WI | $23.78 | $11.40 – $28.44 | 296 | 2 |
| Richland, IA | $28.51 | $28.51 – $28.51 | 295 | 1 |
| Ft Meyers, FL | $28.48 | $28.48 – $28.48 | 294 | 1 |
| Phillipsburg, OH | $56.42 | $56.42 – $56.42 | 294 | 1 |
| Harwood Heights, IL | $21.73 | $12.56 – $47.76 | 294 | 4 |
| Kimper, KY | $53.83 | $53.83 – $53.83 | 293 | 1 |
| Bourbon, MO | $65.04 | $57.32 – $82.72 | 293 | 2 |
| Lyman, WY | $2.67 | $2.67 – $2.67 | 293 | 1 |
| Etna, PA | $49.33 | $46.98 – $51.28 | 293 | 2 |
| Engadine, MI | $37.62 | $37.62 – $37.62 | 293 | 1 |
| Steele, ND | $37.01 | $37.01 – $37.01 | 292 | 1 |
| Marvin, NC | $6.45 | $6.45 – $6.45 | 292 | 1 |
| Charlotte, VT | $62.39 | $62.35 – $63.15 | 291 | 2 |
| Leeds, AL | $7.84 | $0.00 – $67.14 | 291 | 2 |
| Kunkletown, PA | $27.81 | $27.81 – $27.81 | 291 | 1 |
| Hydaburg, AK | $446.61 | $446.61 – $446.61 | 291 | 1 |
| Bozrah, CT | $0.00 | $0.00 – $0.00 | 290 | 1 |
| Howard, WI | $32.97 | $32.97 – $32.97 | 290 | 1 |
| N. Grosvenordale, CT | $57.99 | $57.99 – $57.99 | 290 | 1 |
| Belmar, NJ | $63.52 | $63.52 – $63.52 | 290 | 1 |
| Temple, NH | $8.70 | $8.70 – $8.70 | 290 | 1 |
| Mccrory, AR | $0.00 | $0.00 – $0.00 | 289 | 1 |
| Voorhess, NJ | $73.01 | $73.01 – $73.01 | 289 | 1 |
| Bay Village, OH | $24.78 | $14.09 – $25.32 | 289 | 2 |
| Monroeville, IN | $19.51 | $19.51 – $19.51 | 289 | 1 |
| Springfield Township, NJ | $157.17 | $157.17 – $157.17 | 289 | 1 |
| Woods Cross, UT | $65.60 | $43.38 – $70.75 | 289 | 3 |
| St Roberts, MO | $47.54 | $47.54 – $47.54 | 288 | 1 |
| Chandlersville, OH | $55.74 | $55.74 – $55.74 | 287 | 1 |
| Bowman, ND | $132.20 | $130.48 – $147.49 | 287 | 2 |
| Rothschild, WI | $27.07 | $24.55 – $30.08 | 287 | 2 |
| Mt. Zion, IL | $29.96 | $19.19 – $42.46 | 286 | 3 |
| Lathrop, CA | $1.43 | $1.43 – $1.43 | 286 | 1 |
| Louisville, AL | $39.16 | $39.16 – $39.16 | 286 | 1 |
| Raisin City, CA | $0.00 | $0.00 – $0.00 | 286 | 1 |
| Clyde, KS | $144.52 | $144.52 – $144.52 | 286 | 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.