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 |
|---|---|---|---|---|
| Lucerne Valley, CA | $375.94 | $375.94 – $375.94 | 159 | 1 |
| Adamstown, MD | $171.47 | $109.76 – $235.14 | 159 | 3 |
| Cincinatti, OH | $94.62 | $94.62 – $94.62 | 158 | 1 |
| Tulia, TX | $35.40 | $34.23 – $35.70 | 158 | 2 |
| North Bend, OH | $12.18 | $12.18 – $12.18 | 157 | 1 |
| Cameron, LA | $53.19 | $53.19 – $53.19 | 157 | 1 |
| Flat Rock, AL | $54.76 | $54.76 – $54.76 | 156 | 1 |
| Wrightsville, PA | $51.01 | $51.01 – $51.01 | 156 | 1 |
| Guyton, GA | $62.76 | $62.76 – $62.76 | 156 | 1 |
| Church Hill, MD | $81.43 | $81.43 – $81.43 | 156 | 1 |
| Dallas, WV | $56.17 | $56.17 – $56.17 | 155 | 1 |
| Mazon, IL | $56.23 | $56.23 – $56.23 | 155 | 1 |
| Merkel, TX | $29.27 | $10.98 – $39.82 | 155 | 4 |
| Three Rivers, CA | $7.86 | $0.00 – $11.71 | 155 | 2 |
| Hungtingon, WV | $19.59 | $19.59 – $19.59 | 155 | 1 |
| Mount Sterling, IL | $31.47 | $14.51 – $34.92 | 154 | 3 |
| Portage Lake, ME | $1.51 | $1.51 – $1.51 | 154 | 1 |
| New Ringgold, PA | $24.16 | $24.16 – $24.16 | 154 | 1 |
| Verona, MS | $38.83 | $38.83 – $38.83 | 154 | 1 |
| Fresno, TX | $7.15 | $7.15 – $7.15 | 153 | 1 |
| Grasonville, MD | $88.29 | $72.83 – $135.09 | 153 | 2 |
| Pouno Ridge, NY | $74.91 | $74.91 – $74.91 | 153 | 1 |
| Westtown, NY | $70.86 | $65.23 – $82.82 | 153 | 2 |
| Winfall, NC | $31.72 | $31.72 – $31.72 | 153 | 1 |
| Condado, PR | $63.00 | $63.00 – $63.00 | 153 | 1 |
| Florham, NJ | $26.84 | $26.84 – $26.84 | 153 | 1 |
| Betnel-Park, PA | $15.63 | $15.63 – $15.63 | 152 | 1 |
| Lansdowne, MD | $69.30 | $69.30 – $69.30 | 152 | 1 |
| Rio Hondo, TX | $49.51 | $49.51 – $49.51 | 152 | 1 |
| Lafayette, NY | $58.73 | $58.73 – $58.73 | 151 | 1 |
| Dillon, CO | $54.66 | $46.16 – $61.08 | 151 | 2 |
| Ottuma, IA | $0.00 | $0.00 – $0.00 | 151 | 1 |
| Little Mountain, SC | $69.46 | $69.46 – $69.46 | 151 | 1 |
| Saukville, WI | $18.71 | $18.71 – $18.71 | 151 | 1 |
| Stevenson Ranch, CA | $3.42 | $1.41 – $13.44 | 150 | 3 |
| Ashville, NY | $72.59 | $72.59 – $72.59 | 150 | 1 |
| Pine, AZ | $21.90 | $0.07 – $46.20 | 150 | 2 |
| Los Molinos, CA | $4.68 | $4.68 – $4.68 | 150 | 1 |
| Sumner, TX | $53.04 | $53.04 – $53.04 | 150 | 1 |
| Underwood, ND | $63.95 | $63.95 – $63.95 | 149 | 1 |
| Towner, ND | $47.93 | $47.93 – $47.93 | 149 | 1 |
| Barnardsville, NC | $18.92 | $18.92 – $18.92 | 148 | 1 |
| Rockford, AL | $8.25 | $8.25 – $8.25 | 147 | 1 |
| Cameron, WI | $24.96 | $7.55 – $45.75 | 147 | 2 |
| Vergenes, VT | $26.31 | $26.31 – $26.31 | 147 | 1 |
| Big Stone City, SD | $58.35 | $58.35 – $58.35 | 147 | 1 |
| Rush City, MN | $69.82 | $69.82 – $69.82 | 147 | 1 |
| Navajo Mountain, UT | $632.46 | $632.46 – $632.46 | 147 | 1 |
| Stromberg, NE | $63.36 | $63.36 – $63.36 | 147 | 1 |
| Wellington, NV | $3.91 | $3.91 – $3.91 | 146 | 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.