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 |
|---|---|---|---|---|
| Eads, CO | $84.36 | $47.06 – $152.06 | 182 | 5 |
| Pineland, TX | $31.96 | $31.96 – $31.96 | 182 | 1 |
| Fort Cavasos, TX | $33.14 | $33.14 – $33.14 | 181 | 1 |
| Palm Shores, FL | $79.78 | $79.78 – $79.78 | 181 | 1 |
| Rector, AR | $40.17 | $1.86 – $84.11 | 180 | 3 |
| Port Graham, AK | $239.27 | $217.96 – $313.86 | 180 | 2 |
| Garfiled Heights, OH | $22.38 | $22.38 – $22.38 | 179 | 1 |
| Glasco, KS | $118.38 | $118.38 – $118.38 | 179 | 1 |
| Eliot, ME | $43.38 | $43.38 – $43.38 | 179 | 1 |
| E Mc Keesport, PA | $22.51 | $22.51 – $22.51 | 179 | 1 |
| Darnestown, MD | $95.11 | $95.11 – $95.11 | 179 | 1 |
| De Leon, TX | $0.00 | $0.00 – $0.00 | 179 | 1 |
| Altoona, FL | $21.06 | $21.06 – $21.06 | 177 | 1 |
| Lindsay, NE | $39.91 | $39.91 – $39.91 | 177 | 1 |
| Leetsdale, PA | $56.62 | $27.52 – $72.28 | 177 | 3 |
| Lemars, IA | $0.00 | $0.00 – $0.00 | 177 | 1 |
| Gordonville, PA | $48.74 | $48.74 – $48.74 | 176 | 1 |
| Slidel, LA | $39.32 | $39.32 – $39.32 | 176 | 1 |
| Deshler, OH | $42.55 | $42.55 – $42.55 | 176 | 1 |
| Farmington, Mo, MO | $25.90 | $25.90 – $25.90 | 176 | 1 |
| Penn Valley, PA | $15.29 | $0.00 – $65.27 | 176 | 6 |
| Groton, SD | $31.34 | $31.34 – $31.34 | 175 | 1 |
| Cross Plains, TX | $43.86 | $39.24 – $48.79 | 175 | 4 |
| Lewisville, AR | $10.10 | $8.47 – $18.32 | 175 | 2 |
| East Syaruse, NY | $93.06 | $93.06 – $93.06 | 175 | 1 |
| Schereville, IN | $36.91 | $36.91 – $36.91 | 174 | 1 |
| Gladbrook, IA | $28.47 | $25.28 – $57.69 | 173 | 2 |
| Hanahan, SC | $33.82 | $33.82 – $33.82 | 173 | 1 |
| Conneaut Lake, PA | $0.00 | $0.00 – $0.00 | 173 | 1 |
| North Dinwiddie, VA | $101.76 | $5.92 – $110.91 | 172 | 2 |
| Schenectody, NY | $50.74 | $50.74 – $50.74 | 172 | 1 |
| Kadoka, SD | $70.49 | $70.49 – $70.49 | 172 | 1 |
| Shonto, AZ | $26.18 | $18.16 – $33.48 | 172 | 2 |
| Lake Oswergo, OR | $44.39 | $44.39 – $44.39 | 172 | 1 |
| Mount Victory, OH | $37.52 | $36.92 – $44.81 | 172 | 2 |
| Foreman, AR | $23.08 | $23.08 – $23.08 | 171 | 1 |
| Ft. Gibson, OK | $84.90 | $84.90 – $84.90 | 171 | 1 |
| Syacuse, NY | $129.52 | $129.52 – $129.52 | 171 | 1 |
| Marquez, TX | $117.62 | $117.62 – $117.62 | 170 | 1 |
| Nett Lake, MN | $536.26 | $536.26 – $536.26 | 170 | 1 |
| Mckee, KY | $28.91 | $28.91 – $28.91 | 169 | 1 |
| Killdeer, ND | $252.91 | $113.68 – $286.95 | 168 | 2 |
| Wirtz, VA | $64.97 | $64.97 – $64.97 | 168 | 1 |
| New Tripoli, PA | $35.68 | $28.00 – $38.60 | 168 | 3 |
| Ona, WV | $11.36 | $11.36 – $11.36 | 168 | 1 |
| Palmer, PA | $29.75 | $29.75 – $29.75 | 168 | 1 |
| Wvc, UT | $52.06 | $52.06 – $52.06 | 168 | 1 |
| Persia, IA | $1.19 | $1.19 – $1.19 | 168 | 1 |
| Reynolds, GA | $19.18 | $19.18 – $19.18 | 168 | 1 |
| Tilden, NE | $43.79 | $43.79 – $43.79 | 167 | 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.