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 |
|---|---|---|---|---|
| Mannington, NJ | $109.94 | $108.21 – $122.39 | 254 | 2 |
| Lake Norden, SD | $52.60 | $38.63 – $53.35 | 254 | 2 |
| Murry, KY | $44.44 | $44.44 – $44.44 | 253 | 1 |
| Paul, ID | $71.47 | $71.47 – $71.47 | 253 | 1 |
| Lebo, KS | $29.08 | $26.05 – $42.72 | 253 | 2 |
| Brroklyn, NY | $61.88 | $61.88 – $61.88 | 252 | 1 |
| Portland, OH | $74.63 | $74.63 – $74.63 | 252 | 1 |
| Perry Point, MD | $75.93 | $19.34 – $89.25 | 252 | 2 |
| Lanesborough, MA | $25.71 | $25.71 – $25.71 | 252 | 1 |
| Lakeridge, VA | $20.67 | $20.67 – $20.67 | 252 | 1 |
| Finleyville, PA | $45.82 | $45.82 – $45.82 | 251 | 1 |
| Asbury, NJ | $47.12 | $25.85 – $52.05 | 250 | 2 |
| Drew, MS | $30.86 | $30.86 – $30.86 | 250 | 1 |
| Bristolville, OH | $29.72 | $29.72 – $29.72 | 250 | 1 |
| Nuevo, CA | $0.00 | $0.00 – $0.00 | 249 | 1 |
| Clarkton, NC | $33.54 | $31.71 – $41.63 | 249 | 2 |
| Mattapoisett, MA | $43.80 | $4.87 – $78.52 | 249 | 3 |
| Point Harbor, NC | $34.92 | $34.92 – $34.92 | 248 | 1 |
| Mcclusky, ND | $237.49 | $237.49 – $237.49 | 247 | 1 |
| Albuqurque, NM | $48.83 | $41.67 – $54.67 | 247 | 2 |
| Grand Saline, TX | $12.14 | $12.14 – $12.14 | 247 | 1 |
| Mailuku, HI | $29.08 | $29.08 – $29.08 | 247 | 1 |
| Monarch Beach, CA | $63.09 | $63.09 – $63.09 | 247 | 1 |
| Spring Grove, IL | $48.51 | $48.51 – $48.51 | 247 | 1 |
| New Hebron, MS | $25.37 | $25.37 – $25.37 | 247 | 1 |
| Essex, VT | $73.33 | $73.33 – $73.33 | 246 | 1 |
| Randolph, NE | $121.75 | $111.50 – $122.33 | 246 | 2 |
| Lakeville, IN | $50.73 | $41.34 – $56.84 | 246 | 2 |
| Pine Hall, NC | $14.78 | $14.78 – $14.78 | 245 | 1 |
| Hamersville, OH | $18.85 | $18.85 – $18.85 | 245 | 1 |
| Ash Grove, MO | $15.92 | $10.54 – $104.76 | 245 | 2 |
| Moreno, CA | $7.79 | $7.79 – $7.79 | 244 | 1 |
| Dlberville, MS | $32.26 | $32.26 – $32.26 | 244 | 1 |
| Townson, MD | $75.86 | $75.86 – $75.86 | 244 | 1 |
| Ancora, NJ | $63.92 | $63.92 – $63.92 | 244 | 1 |
| Riverdale, IL | $50.36 | $50.36 – $50.36 | 244 | 1 |
| Calhoun, KY | $33.75 | $31.65 – $63.23 | 243 | 3 |
| Brackettville, TX | $0.00 | $0.00 – $0.00 | 243 | 1 |
| Bridegport, CT | $50.55 | $50.55 – $50.55 | 243 | 1 |
| Montezuma, IA | $2.99 | $0.00 – $51.76 | 242 | 2 |
| Van Meter, IA | $182.17 | $182.17 – $182.17 | 242 | 1 |
| Lyons, NJ | $30.61 | $6.89 – $32.41 | 241 | 2 |
| Humboldt, NE | $111.44 | $111.44 – $111.44 | 241 | 1 |
| Mazomanie, WI | $26.64 | $26.64 – $26.64 | 241 | 1 |
| U Saddle Riv, NJ | $79.58 | $79.58 – $79.58 | 240 | 1 |
| S Portland, ME | $22.75 | $22.12 – $32.99 | 240 | 2 |
| Ellis, KS | $124.99 | $124.99 – $124.99 | 239 | 1 |
| Everette, MA | $47.73 | $47.73 – $47.73 | 239 | 1 |
| New Ipswich, NH | $48.18 | $44.00 – $59.30 | 238 | 2 |
| Haskell, TX | $16.94 | $5.85 – $25.70 | 238 | 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.