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 |
|---|---|---|---|---|
| Astonia, OR | $55.52 | $55.52 – $55.52 | 194 | 1 |
| Hollister, NC | $2.99 | $0.00 – $4.27 | 193 | 2 |
| Eighty Four, PA | $43.71 | $43.71 – $43.71 | 193 | 1 |
| Hendricks, MN | $50.08 | $43.99 – $122.38 | 193 | 2 |
| Highland, MD | $99.49 | $99.49 – $99.49 | 192 | 1 |
| Bethune, SC | $204.72 | $204.72 – $204.72 | 192 | 1 |
| Cottondale, FL | $50.16 | $50.16 – $50.16 | 192 | 1 |
| Marienville, PA | $0.00 | $0.00 – $0.00 | 191 | 1 |
| Philadelphi, PA | $42.79 | $42.79 – $42.79 | 191 | 1 |
| Jbsa Fort Sam Houston, TX | $35.60 | $31.67 – $35.87 | 191 | 2 |
| Bradley, AR | $15.74 | $15.74 – $15.74 | 191 | 1 |
| Vahalla, NY | $68.16 | $68.16 – $68.16 | 191 | 1 |
| Tequesta, FL | $9.84 | $5.45 – $24.98 | 191 | 2 |
| Northport, MI | $55.32 | $41.33 – $57.73 | 191 | 2 |
| Cove, AR | $26.39 | $26.39 – $26.39 | 191 | 1 |
| Centerville Finance, OH | $29.81 | $29.81 – $29.81 | 190 | 1 |
| West Long Beach, NJ | $42.37 | $42.37 – $42.37 | 190 | 1 |
| Clear, AK | $269.97 | $269.97 – $269.97 | 190 | 1 |
| Bessemer, MI | $40.46 | $40.46 – $40.46 | 190 | 1 |
| Cokeburg, PA | $0.00 | $0.00 – $0.00 | 190 | 1 |
| Lumberport, WV | $35.53 | $35.53 – $35.53 | 190 | 1 |
| Lone Star, TX | $14.42 | $14.42 – $14.42 | 190 | 1 |
| Saint Simons Island, GA | $25.06 | $25.06 – $25.06 | 189 | 1 |
| West Columbia, TX | $24.70 | $22.96 – $46.48 | 189 | 2 |
| Woodbridge, CA | $40.57 | $40.57 – $40.57 | 189 | 1 |
| Enfield, NC | $4.05 | $0.00 – $6.43 | 189 | 2 |
| New Providnce, PA | $42.07 | $42.07 – $42.07 | 188 | 1 |
| Leavittsburg, OH | $96.07 | $96.07 – $96.07 | 188 | 1 |
| Corbett, OR | $66.04 | $66.04 – $66.04 | 188 | 1 |
| St. Helena, CA | $26.64 | $18.60 – $32.23 | 187 | 3 |
| Donnelly, ID | $52.97 | $52.97 – $52.97 | 187 | 1 |
| Belmont, MI | $43.08 | $43.08 – $43.08 | 187 | 1 |
| Mt. Laurel, NJ | $137.74 | $54.25 – $170.13 | 186 | 2 |
| Strathmore, CA | $20.23 | $20.23 – $20.23 | 186 | 1 |
| Marysville, PA | $102.53 | $82.50 – $105.79 | 186 | 2 |
| Stratford, IA | $15.97 | $0.00 – $44.33 | 186 | 2 |
| Croswell, MI | $51.18 | $51.18 – $51.18 | 185 | 1 |
| Mineapolis, MN | $64.96 | $64.96 – $64.96 | 185 | 1 |
| Woodbourne, NY | $76.03 | $76.03 – $76.03 | 185 | 1 |
| Cula Vista, CA | $3.95 | $3.95 – $3.95 | 185 | 1 |
| Keene, NY | $38.03 | $38.03 – $38.03 | 184 | 1 |
| Jay, VT | $0.00 | $0.00 – $0.00 | 184 | 1 |
| Belle Center, OH | $137.56 | $137.56 – $137.56 | 184 | 1 |
| Port Jeff Sta, NY | $36.39 | $36.39 – $36.39 | 184 | 1 |
| Esparto, CA | $2.55 | $2.55 – $2.55 | 183 | 1 |
| Louin, MS | $19.43 | $19.43 – $19.43 | 183 | 1 |
| Sunset Beach, CA | $6.65 | $6.65 – $6.65 | 183 | 1 |
| Wassaic, NY | $95.02 | $93.89 – $111.21 | 183 | 2 |
| Pojoaque, NM | $48.91 | $48.91 – $48.91 | 183 | 1 |
| Spanishburg, WV | $57.07 | $57.07 – $57.07 | 182 | 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.