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 |
|---|---|---|---|---|
| Clyde, NY | $73.58 | $64.90 – $75.28 | 207 | 2 |
| Mayagues, PR | $29.60 | $29.60 – $29.60 | 207 | 1 |
| Cologne, MN | $42.63 | $42.63 – $42.63 | 207 | 1 |
| Owings, MD | $58.52 | $24.75 – $89.28 | 207 | 3 |
| Owosoo, MI | $50.27 | $50.27 – $50.27 | 206 | 1 |
| Winters, TX | $17.89 | $15.06 – $19.81 | 206 | 2 |
| Clayton, CA | $176.52 | $176.52 – $176.52 | 206 | 1 |
| Harbinger, NC | $79.14 | $79.14 – $79.14 | 206 | 1 |
| Cary, IL | $34.59 | $25.67 – $48.45 | 206 | 3 |
| Chesterland, Oh, OH | $39.92 | $39.92 – $39.92 | 205 | 1 |
| Racine, WV | $39.50 | $39.50 – $39.50 | 205 | 1 |
| Melba, ID | $0.00 | $0.00 – $0.00 | 205 | 2 |
| Wilkinsburg, PA | $0.17 | $0.17 – $0.17 | 204 | 1 |
| Yorktown, NY | $145.71 | $145.71 – $145.71 | 204 | 1 |
| Thorsby, AL | $0.00 | $0.00 – $0.00 | 204 | 1 |
| Berlin, MA | $65.64 | $63.62 – $73.68 | 204 | 2 |
| Bacliff, TX | $15.20 | $15.20 – $15.20 | 203 | 1 |
| Grandin, FL | $80.23 | $80.23 – $80.23 | 203 | 1 |
| Omro, WI | $29.35 | $16.87 – $38.07 | 203 | 4 |
| Isabel, SD | $153.34 | $153.34 – $153.34 | 203 | 1 |
| New Melle, MO | $69.25 | $69.25 – $69.25 | 203 | 1 |
| St Paul, NE | $147.71 | $147.71 – $147.71 | 202 | 1 |
| N Royalton, OH | $43.56 | $43.56 – $43.56 | 202 | 1 |
| Sugarcreek Township, OH | $29.28 | $29.28 – $29.28 | 202 | 1 |
| Rockwell, IA | $27.57 | $27.39 – $30.18 | 201 | 2 |
| Hinsdale, NH | $43.92 | $43.92 – $43.92 | 201 | 1 |
| Little Rock Afb, AR | $73.49 | $61.56 – $80.41 | 201 | 3 |
| Lucas, OH | $32.34 | $32.34 – $32.34 | 201 | 1 |
| Marengo, IL | $32.92 | $7.30 – $41.18 | 201 | 2 |
| Hiram, ME | $37.44 | $0.00 – $47.39 | 200 | 2 |
| Tyndall, Afb, FL | $62.74 | $62.74 – $62.74 | 200 | 1 |
| Leetonia, OH | $37.98 | $37.98 – $37.98 | 200 | 1 |
| Duquoin, IL | $5.59 | $5.59 – $5.59 | 199 | 1 |
| Bryant, SD | $116.76 | $116.76 – $116.76 | 199 | 1 |
| Newport, NJ | $5.24 | $5.24 – $5.24 | 199 | 1 |
| Anderson, OH | $34.06 | $34.06 – $34.06 | 198 | 1 |
| Palo, IA | $29.92 | $29.92 – $29.92 | 198 | 1 |
| Yauco, Puerto Rico, PR | $23.85 | $23.85 – $23.85 | 198 | 1 |
| South Padre Island, TX | $0.00 | $0.00 – $0.00 | 198 | 1 |
| Chatt, TN | $34.57 | $34.57 – $34.57 | 198 | 1 |
| Drexel, NC | $66.27 | $66.27 – $66.27 | 197 | 1 |
| Gruetli Laager, TN | $7.46 | $7.46 – $7.46 | 197 | 1 |
| Rumford, RI | $45.66 | $10.10 – $89.67 | 196 | 3 |
| Earlham, IA | $0.00 | $0.00 – $0.00 | 196 | 1 |
| Massena, IA | $3.53 | $3.53 – $3.53 | 196 | 1 |
| Three Rivers, TX | $41.75 | $37.45 – $53.84 | 196 | 4 |
| Avis, PA | $29.94 | $19.39 – $56.32 | 196 | 3 |
| Krugerville, TX | $26.42 | $26.42 – $26.42 | 196 | 1 |
| Jefferson Hls, PA | $22.36 | $22.36 – $22.36 | 195 | 1 |
| Allas, TX | $5.97 | $5.97 – $5.97 | 194 | 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.