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 |
|---|---|---|---|---|
| Paauilo, HI | $67.23 | $67.23 – $67.23 | 285 | 1 |
| Alexander, AR | $47.54 | $15.75 – $60.95 | 285 | 3 |
| Middlefield, CT | $9.76 | $9.07 – $24.15 | 285 | 2 |
| Mammoth Springs, AR | $76.79 | $76.79 – $76.79 | 284 | 1 |
| Bandera, TX | $35.60 | $23.28 – $71.81 | 284 | 3 |
| Kendrick, ID | $5.93 | $4.03 – $6.19 | 282 | 2 |
| Pfafftown, NC | $57.47 | $55.63 – $71.84 | 282 | 2 |
| Keystone, IA | $20.95 | $20.95 – $20.95 | 282 | 1 |
| Clifton, TX | $33.65 | $28.86 – $41.45 | 282 | 3 |
| Wood Ridge, NJ | $8.69 | $8.69 – $8.69 | 281 | 1 |
| Paduch, KY | $42.00 | $42.00 – $42.00 | 281 | 1 |
| Floodwood, MN | $66.55 | $36.61 – $75.02 | 281 | 2 |
| Ewa, HI | $0.00 | $0.00 – $0.00 | 280 | 1 |
| Creestwood, KY | $42.41 | $42.41 – $42.41 | 280 | 1 |
| Oak Hills, CA | $41.47 | $10.80 – $53.73 | 280 | 2 |
| Ocean Township, NJ | $97.83 | $97.83 – $97.83 | 280 | 1 |
| Koyuk, AK | $413.35 | $413.35 – $413.35 | 280 | 1 |
| Langley Afb, VA | $127.32 | $93.86 – $150.44 | 279 | 2 |
| Deerfield, WI | $38.76 | $38.76 – $38.76 | 277 | 1 |
| Naselle, WA | $60.22 | $22.50 – $62.23 | 277 | 2 |
| Greensboro, PA | $0.00 | $0.00 – $0.00 | 276 | 3 |
| S Hamilton, MA | $52.00 | $45.92 – $52.80 | 276 | 2 |
| Cutchogue, NY | $109.10 | $107.23 – $117.97 | 276 | 2 |
| Oakland Gdns, NY | $86.14 | $86.14 – $86.14 | 276 | 1 |
| Stratford, TX | $34.26 | $34.26 – $34.26 | 276 | 1 |
| Shuqualak, MS | $69.67 | $69.67 – $69.67 | 276 | 1 |
| Aice, TX | $45.66 | $45.66 – $45.66 | 276 | 1 |
| Banger, ME | $21.16 | $21.16 – $21.16 | 274 | 1 |
| Belpre, KS | $30.51 | $30.51 – $30.51 | 274 | 1 |
| Grantham, NH | $35.23 | $35.23 – $35.23 | 274 | 1 |
| Crandall, TX | $60.08 | $60.08 – $60.08 | 274 | 1 |
| Angoon, AK | $348.54 | $125.13 – $749.77 | 274 | 2 |
| Bertram, TX | $73.29 | $73.29 – $73.29 | 274 | 1 |
| Bonaparte, IA | $0.00 | $0.00 – $0.00 | 273 | 1 |
| Cashmere, WA | $84.11 | $12.56 – $87.41 | 272 | 2 |
| Elwood, IL | $3.72 | $3.72 – $3.72 | 272 | 1 |
| Lacygne, KS | $69.12 | $69.12 – $69.12 | 272 | 1 |
| St. Anthony, MN | $56.38 | $56.38 – $56.38 | 272 | 1 |
| West Rutland, VT | $15.88 | $15.88 – $15.88 | 272 | 1 |
| Engelhard, NC | $0.53 | $0.53 – $0.53 | 271 | 1 |
| Franklinville, NY | $77.55 | $57.59 – $79.94 | 271 | 2 |
| Dimmitt, TX | $11.09 | $0.00 – $12.69 | 271 | 4 |
| Deerfield Bch, FL | $51.46 | $51.46 – $51.46 | 271 | 1 |
| Pahrumph, NV | $29.40 | $29.40 – $29.40 | 270 | 1 |
| Rancho Cucomonga, CA | $13.42 | $13.42 – $13.42 | 270 | 1 |
| Volente, TX | $12.10 | $12.10 – $12.10 | 270 | 1 |
| Marble, NC | $497.31 | $497.31 – $497.31 | 269 | 1 |
| Millen, GA | $50.53 | $50.53 – $50.53 | 269 | 1 |
| Granville, MA | $75.78 | $75.78 – $75.78 | 268 | 1 |
| Lk. Mary, FL | $69.47 | $69.47 – $69.47 | 268 | 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.