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 |
|---|---|---|---|---|
| Ludlow, KY | $32.15 | $32.15 – $32.15 | 267 | 1 |
| Menard, IL | $106.27 | $106.27 – $106.27 | 267 | 1 |
| Aspermont, TX | $34.08 | $15.17 – $38.55 | 267 | 2 |
| Rotan, TX | $182.29 | $45.53 – $244.32 | 266 | 2 |
| Hallettsville, TX | $32.81 | $2.30 – $34.89 | 266 | 2 |
| Priest River, ID | $4.47 | $0.00 – $4.75 | 266 | 2 |
| Calverton, NY | $22.75 | $22.75 – $22.75 | 266 | 1 |
| Sepulveda, CA | $0.00 | $0.00 – $0.00 | 266 | 1 |
| Lisbon, NH | $42.34 | $42.34 – $42.34 | 265 | 1 |
| Salisbury, PA | $48.61 | $48.61 – $48.61 | 265 | 1 |
| Lake Carmel, NY | $101.85 | $101.85 – $101.85 | 265 | 1 |
| Mc Crory, AR | $1.08 | $0.00 – $1.63 | 265 | 3 |
| Newcastle, ME | $41.48 | $16.82 – $49.01 | 265 | 2 |
| Cressona, PA | $26.78 | $26.78 – $26.78 | 265 | 1 |
| Diamondville, WY | $62.72 | $62.72 – $62.72 | 264 | 1 |
| Wilder, VT | $61.26 | $61.26 – $61.26 | 264 | 1 |
| Bonesteel, SD | $88.22 | $88.22 – $88.22 | 264 | 1 |
| Caledonia, OH | $52.71 | $52.71 – $52.71 | 264 | 1 |
| Rush Springs, OK | $76.77 | $76.77 – $76.77 | 262 | 1 |
| Pike Road, AL | $40.21 | $0.00 – $55.02 | 261 | 5 |
| Brielle, NJ | $4.49 | $1.45 – $45.46 | 261 | 2 |
| Hamlin, PA | $38.80 | $38.80 – $38.80 | 261 | 1 |
| St.Thomas, VI | $32.18 | $32.18 – $32.18 | 261 | 1 |
| Mount Desert, ME | $18.12 | $18.12 – $18.12 | 261 | 1 |
| Mountain Home Afb, ID | $44.95 | $44.95 – $44.95 | 261 | 1 |
| Fultonville, NY | $124.21 | $124.21 – $124.21 | 260 | 1 |
| Trenton, ND | $314.03 | $314.03 – $314.03 | 260 | 1 |
| Bargersville, IN | $55.08 | $42.03 – $57.96 | 260 | 2 |
| Poter Ranch, CA | $56.86 | $56.86 – $56.86 | 260 | 1 |
| Junction, TX | $21.94 | $21.94 – $21.94 | 259 | 1 |
| Fe Warren Afb, WY | $58.58 | $56.83 – $63.83 | 259 | 2 |
| Leomister, MA | $27.52 | $27.52 – $27.52 | 259 | 1 |
| Willow Spring, NC | $10.42 | $6.14 – $91.32 | 259 | 2 |
| Mohall, ND | $51.07 | $51.07 – $51.07 | 258 | 1 |
| Vorhees Township, NJ | $137.65 | $137.65 – $137.65 | 258 | 1 |
| Ft. Bidwell, CA | $0.00 | $0.00 – $0.00 | 258 | 1 |
| Green River, UT | $116.74 | $26.51 – $125.34 | 258 | 3 |
| Eastover, SC | $187.35 | $56.91 – $240.97 | 258 | 4 |
| Phildadelphia, PA | $0.00 | $0.00 – $0.00 | 257 | 1 |
| Victor, IA | $2.98 | $0.00 – $7.29 | 257 | 2 |
| Alexandria, NH | $0.00 | $0.00 – $0.00 | 257 | 1 |
| Youngsville, PA | $44.26 | $44.26 – $44.26 | 257 | 1 |
| Hammond, NY | $66.91 | $66.91 – $66.91 | 257 | 1 |
| Union Beach, NJ | $13.10 | $1.81 – $13.71 | 256 | 2 |
| Calimesa, CA | $54.56 | $54.56 – $54.56 | 256 | 1 |
| Ashley, ND | $152.42 | $141.71 – $183.05 | 255 | 3 |
| W Somerset, KY | $62.28 | $62.28 – $62.28 | 255 | 1 |
| Clayton, DE | $14.04 | $14.04 – $14.04 | 255 | 1 |
| Rushford, MN | $36.83 | $34.79 – $48.13 | 255 | 2 |
| North Brookfield, MA | $37.44 | $33.00 – $47.11 | 255 | 3 |
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.