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 |
|---|---|---|---|---|
| Villanova, PA | $14.84 | $14.72 – $15.88 | 146 | 2 |
| Atlantic, FL | $30.21 | $30.21 – $30.21 | 146 | 1 |
| New Boston, NH | $54.18 | $54.18 – $54.18 | 146 | 1 |
| Waterford City, ND | $143.20 | $143.20 – $143.20 | 146 | 1 |
| Thornwood, NY | $34.05 | $18.14 – $51.58 | 145 | 2 |
| Pass Christian, MS | $38.26 | $18.55 – $49.11 | 145 | 3 |
| Saunemin, IL | $57.22 | $57.22 – $57.22 | 145 | 1 |
| Baldwin Harbor, NY | $78.44 | $78.44 – $78.44 | 145 | 1 |
| Jarrell, TX | $47.16 | $47.16 – $47.16 | 144 | 1 |
| Republic, PA | $3.74 | $3.74 – $3.74 | 144 | 1 |
| Saylorsburg, PA | $12.08 | $12.08 – $12.08 | 144 | 1 |
| Palacios, TX | $20.11 | $20.11 – $20.11 | 144 | 1 |
| Denver City, TX | $26.48 | $26.48 – $26.48 | 144 | 1 |
| Aspinwall, PA | $33.46 | $33.46 – $33.46 | 143 | 1 |
| Marbleton, WY | $38.55 | $36.23 – $59.97 | 143 | 2 |
| Templeton, IA | $47.92 | $47.92 – $47.92 | 143 | 1 |
| Mirror Lake, NH | $54.34 | $54.34 – $54.34 | 143 | 1 |
| Niobrara, NE | $15.73 | $0.00 – $82.13 | 142 | 3 |
| Huntington Bch, CA | $145.23 | $145.23 – $145.23 | 142 | 1 |
| Duck, WV | $38.98 | $38.98 – $38.98 | 142 | 1 |
| Mackinac Island, MI | $58.04 | $58.04 – $58.04 | 142 | 1 |
| Ransom, KS | $162.78 | $162.78 – $162.78 | 142 | 1 |
| Imperial, PA | $44.71 | $44.11 – $44.94 | 142 | 2 |
| Trinidad, TX | $22.77 | $22.77 – $22.77 | 142 | 1 |
| Weirsdale, FL | $35.29 | $30.32 – $40.19 | 141 | 2 |
| Baggs, WY | $0.00 | $0.00 – $0.00 | 141 | 1 |
| Parkin, AR | $0.75 | $0.43 – $1.87 | 141 | 2 |
| Ft Cavazos, TX | $51.15 | $51.15 – $51.15 | 141 | 1 |
| West Nyac, NY | $17.38 | $17.38 – $17.38 | 141 | 1 |
| Adrian, MN | $45.41 | $45.41 – $45.41 | 141 | 1 |
| Estelline, SD | $56.90 | $56.90 – $56.90 | 140 | 1 |
| Cincinnati Ohio, OH | $29.97 | $29.97 – $29.97 | 140 | 1 |
| St Edward, NE | $65.26 | $65.26 – $65.26 | 140 | 1 |
| Attchison, KS | $138.75 | $138.75 – $138.75 | 140 | 1 |
| Ponca, NE | $54.55 | $49.24 – $85.45 | 140 | 3 |
| Bells, TX | $9.89 | $9.89 – $9.89 | 140 | 1 |
| Warrenville Heights, OH | $27.61 | $27.61 – $27.61 | 139 | 1 |
| Sauk Rapids, MN | $49.71 | $22.74 – $55.82 | 139 | 3 |
| Adamstown, PA | $1.73 | $1.73 – $1.73 | 139 | 1 |
| Elkview, WV | $62.22 | $62.22 – $62.22 | 139 | 1 |
| Fox Lake, IL | $47.07 | $47.07 – $47.07 | 139 | 1 |
| Paden, OK | $35.92 | $35.92 – $35.92 | 138 | 1 |
| Richardton, ND | $122.42 | $122.42 – $122.42 | 138 | 1 |
| Croton, NY | $88.77 | $51.55 – $93.66 | 138 | 2 |
| Zirconia, NC | $6.47 | $6.47 – $6.47 | 138 | 1 |
| Enderlin, ND | $115.34 | $70.34 – $135.71 | 138 | 2 |
| St. George, WV | $0.00 | $0.00 – $0.00 | 137 | 1 |
| Yanceville, NC | $37.38 | $37.38 – $37.38 | 137 | 1 |
| Imboden, AR | $13.81 | $13.81 – $13.81 | 137 | 1 |
| Wister, OK | $654.00 | $654.00 – $654.00 | 137 | 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.