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 |
|---|---|---|---|---|
| Tilden, NE | $43.79 | $43.79 – $43.79 | 167 | 1 |
| Hines, MN | $175.62 | $175.62 – $175.62 | 166 | 1 |
| Murfreesboro, AR | $27.39 | $23.34 – $33.51 | 166 | 3 |
| Manzanita, OR | $110.17 | $110.17 – $110.17 | 166 | 1 |
| Shakoee, MN | $62.34 | $62.34 – $62.34 | 166 | 1 |
| Sudan, TX | $21.95 | $21.95 – $21.95 | 166 | 1 |
| Grottoes, VA | $45.50 | $45.50 – $45.50 | 166 | 1 |
| Clarksburg, NJ | $16.07 | $16.07 – $16.07 | 165 | 1 |
| Garrison, TX | $38.06 | $38.06 – $38.06 | 165 | 1 |
| Lynch, NE | $37.03 | $37.03 – $37.03 | 165 | 1 |
| Trinity, NC | $53.79 | $47.16 – $68.61 | 165 | 2 |
| Wolcott, IN | $50.60 | $50.60 – $50.60 | 165 | 1 |
| Danville, OH | $155.59 | $5.84 – $310.88 | 165 | 2 |
| Dixon, IA | $3.35 | $3.35 – $3.35 | 164 | 1 |
| New Hope, PA | $9.71 | $9.71 – $9.71 | 164 | 1 |
| Barkhamsted, CT | $42.55 | $42.55 – $42.55 | 164 | 1 |
| Humphrey, NE | $37.41 | $37.41 – $37.41 | 164 | 1 |
| Nashville Tn, TN | $36.78 | $36.78 – $36.78 | 164 | 1 |
| Ault, CO | $91.00 | $91.00 – $91.00 | 164 | 1 |
| Landenberg, PA | $114.43 | $20.00 – $123.93 | 164 | 2 |
| Bearden, AR | $31.14 | $31.14 – $31.14 | 164 | 1 |
| Pine Bluffs, WY | $17.33 | $17.33 – $17.33 | 164 | 1 |
| Winfiled, AL | $0.00 | $0.00 – $0.00 | 163 | 1 |
| Moseley, VA | $57.81 | $57.81 – $57.81 | 163 | 1 |
| Tatum, TX | $11.17 | $1.57 – $12.83 | 163 | 2 |
| Warner, OK | $44.96 | $44.96 – $44.96 | 163 | 1 |
| Bridgewille, PA | $28.13 | $28.13 – $28.13 | 163 | 1 |
| Drewryville, VA | $63.77 | $63.77 – $63.77 | 162 | 1 |
| Hambleton, WV | $56.97 | $56.97 – $56.97 | 162 | 1 |
| Huson, MT | $66.05 | $66.05 – $66.05 | 162 | 1 |
| Rockland, DE | $89.76 | $89.76 – $89.76 | 161 | 1 |
| Arcadia, MI | $62.81 | $62.81 – $62.81 | 161 | 1 |
| Wilkeson, WA | $62.49 | $62.49 – $62.49 | 161 | 1 |
| Minneapolis, Mn, MN | $60.57 | $60.57 – $60.57 | 161 | 1 |
| Arbutus, MD | $190.50 | $190.50 – $190.50 | 161 | 1 |
| Pleasant Valley, CT | $71.73 | $71.73 – $71.73 | 161 | 1 |
| Hull, TX | $21.97 | $21.97 – $21.97 | 161 | 1 |
| Burgin, KY | $37.60 | $37.60 – $37.60 | 161 | 1 |
| Horse Shoe, NC | $73.77 | $73.77 – $73.77 | 161 | 1 |
| Chas, SC | $37.40 | $37.40 – $37.40 | 160 | 1 |
| White Cloud, KS | $405.78 | $374.89 – $501.60 | 160 | 2 |
| Jbsa Ft Sam Houston, TX | $48.57 | $9.45 – $166.15 | 160 | 5 |
| Brooklyn, AL | $0.00 | $0.00 – $0.00 | 160 | 1 |
| Milford, NY | $55.29 | $52.50 – $56.13 | 160 | 2 |
| Mulberry, IN | $32.29 | $32.29 – $32.29 | 160 | 1 |
| Lucerne Valley, CA | $375.94 | $375.94 – $375.94 | 159 | 1 |
| Adamstown, MD | $171.47 | $109.76 – $235.14 | 159 | 3 |
| Le Sueur, MN | $71.60 | $60.96 – $88.34 | 159 | 4 |
| D'Ilberville, MS | $37.25 | $37.25 – $37.25 | 159 | 1 |
| Colonie, NY | $99.49 | $99.49 – $99.49 | 159 | 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.