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 |
|---|---|---|---|---|
| Rosebud, TX | $26.97 | $26.97 – $26.97 | 238 | 1 |
| Mcconnellsburg, PA | $26.29 | $26.29 – $26.29 | 238 | 1 |
| Dayton, MN | $111.81 | $111.81 – $111.81 | 237 | 1 |
| Ganado, TX | $35.93 | $19.31 – $37.97 | 237 | 2 |
| Maringouin, LA | $0.00 | $0.00 – $0.00 | 237 | 2 |
| Blng Spg Lks, NC | $60.20 | $60.20 – $60.20 | 237 | 1 |
| Pinedale, WY | $55.28 | $50.78 – $58.16 | 236 | 3 |
| Port Ranch, CA | $17.58 | $17.58 – $17.58 | 236 | 1 |
| La Veta, CO | $73.04 | $73.04 – $73.04 | 236 | 1 |
| Harrisonburg, LA | $0.00 | $0.00 – $0.00 | 235 | 1 |
| Indian Lake, NY | $53.27 | $53.27 – $53.27 | 235 | 1 |
| Wauwautosa, WI | $31.57 | $31.57 – $31.57 | 235 | 1 |
| Mineral Wells, WV | $50.39 | $50.39 – $50.39 | 235 | 1 |
| King City, MO | $77.54 | $64.09 – $83.16 | 234 | 2 |
| Netawaka, KS | $34.34 | $31.06 – $37.20 | 234 | 2 |
| Farmingdale, ME | $35.67 | $17.13 – $37.30 | 234 | 2 |
| Hazelhurst, MS | $35.80 | $35.80 – $35.80 | 233 | 1 |
| Luck, WI | $48.01 | $19.44 – $82.51 | 233 | 3 |
| Jamaica Queens, NY | $25.26 | $25.26 – $25.26 | 233 | 1 |
| Brookhaven, PA | $50.37 | $12.51 – $83.41 | 233 | 3 |
| Chattahoochee Hills, GA | $119.11 | $119.11 – $119.11 | 233 | 1 |
| Tougaloo, MS | $33.70 | $33.70 – $33.70 | 232 | 1 |
| Carmichaels, PA | $0.00 | $0.00 – $0.00 | 232 | 1 |
| Ashburnham, MA | $41.40 | $22.14 – $54.03 | 232 | 3 |
| Hollow Rock, TN | $142.19 | $142.19 – $142.19 | 232 | 1 |
| Warren, IL | $56.37 | $56.37 – $56.37 | 232 | 1 |
| Seneca, MO | $48.99 | $48.99 – $48.99 | 231 | 1 |
| Rich Creek, VA | $36.97 | $36.97 – $36.97 | 231 | 1 |
| Lowell, NC | $79.22 | $79.22 – $79.22 | 231 | 1 |
| Abernathy, TX | $5.52 | $5.52 – $5.52 | 231 | 1 |
| Mia, FL | $18.84 | $18.84 – $18.84 | 230 | 1 |
| Shaktoolik, AK | $411.22 | $0.00 – $469.33 | 230 | 3 |
| Bellville, TX | $35.73 | $21.26 – $59.09 | 230 | 2 |
| Arcibo, PR | $9.80 | $9.80 – $9.80 | 229 | 1 |
| Aurora, NY | $57.87 | $57.08 – $67.12 | 229 | 2 |
| Maddock, ND | $586.52 | $586.52 – $586.52 | 228 | 1 |
| Burkburnett, TX | $35.07 | $0.00 – $42.92 | 228 | 4 |
| Golden City, MO | $67.05 | $49.34 – $80.66 | 228 | 3 |
| Eldora, IA | $34.13 | $33.51 – $36.68 | 227 | 2 |
| Clarksville, IA | $4.01 | $2.04 – $31.85 | 227 | 2 |
| Jewett, OH | $27.62 | $27.62 – $27.62 | 227 | 1 |
| Norridgewock, ME | $34.93 | $34.05 – $35.00 | 225 | 2 |
| Kemah, TX | $49.85 | $49.85 – $49.85 | 225 | 1 |
| Repton, AL | $0.00 | $0.00 – $0.00 | 225 | 1 |
| Alvarado, TX | $41.34 | $33.29 – $44.85 | 224 | 2 |
| Maysville, MO | $66.89 | $66.76 – $67.02 | 223 | 2 |
| Utqiagvik, AK | $604.11 | $604.11 – $604.11 | 223 | 1 |
| Kimberton, PA | $42.58 | $42.58 – $42.58 | 222 | 1 |
| Doraville, GA | $69.58 | $8.72 – $101.99 | 222 | 3 |
| Ehrhardt, SC | $174.35 | $174.35 – $174.35 | 222 | 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.