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 |
|---|---|---|---|---|
| Lockport, LA | $18.10 | $17.52 – $21.14 | 136 | 2 |
| Devine, TX | $30.58 | $30.58 – $30.58 | 136 | 1 |
| Morrow, OH | $42.83 | $42.83 – $42.83 | 136 | 1 |
| Garden City, GA | $30.10 | $30.10 – $30.10 | 136 | 1 |
| Northwood, ND | $141.01 | $116.38 – $160.96 | 135 | 3 |
| Arapahoe, NE | $97.40 | $97.40 – $97.40 | 135 | 1 |
| Pangburn, AR | $0.12 | $0.12 – $0.12 | 135 | 1 |
| Lackland Air Force Base, TX | $0.00 | $0.00 – $0.00 | 134 | 1 |
| Hopkins, SC | $205.42 | $193.25 – $240.97 | 134 | 3 |
| Circleville, UT | $73.88 | $73.88 – $73.88 | 134 | 1 |
| Manhasett, NY | $86.66 | $86.66 – $86.66 | 134 | 1 |
| Wilson, WY | $63.73 | $63.73 – $63.73 | 134 | 1 |
| Fairview, OR | $75.24 | $75.24 – $75.24 | 134 | 1 |
| Glen Haven, CO | $95.49 | $95.49 – $95.49 | 134 | 1 |
| Wall Lake, IA | $32.04 | $32.04 – $32.04 | 134 | 1 |
| Export, PA | $21.69 | $0.00 – $31.13 | 134 | 3 |
| King City, OR | $66.79 | $66.79 – $66.79 | 133 | 1 |
| Bumpass, VA | $32.52 | $32.52 – $32.52 | 133 | 1 |
| Manakin Sabot, VA | $38.26 | $35.89 – $41.49 | 133 | 3 |
| Star Tannery, VA | $51.49 | $51.49 – $51.49 | 133 | 1 |
| Thorne Bay, AK | $502.18 | $502.18 – $502.18 | 133 | 1 |
| Leadington, MO | $53.12 | $48.10 – $95.50 | 132 | 2 |
| Walls, MS | $7.72 | $7.72 – $7.72 | 132 | 1 |
| White City, KS | $151.92 | $151.92 – $151.92 | 131 | 1 |
| Town Creek, AL | $219.85 | $219.85 – $219.85 | 131 | 1 |
| Pea Ridge, AR | $20.60 | $20.60 – $20.60 | 130 | 1 |
| St. Paul, VA | $55.51 | $44.74 – $59.47 | 130 | 2 |
| Ben Lomond, CA | $34.93 | $34.93 – $34.93 | 130 | 1 |
| Charlotte Harbor, FL | $400.45 | $400.45 – $400.45 | 130 | 1 |
| Idaho City, ID | $70.07 | $70.07 – $70.07 | 129 | 1 |
| Franklin, GA | $46.28 | $46.28 – $46.28 | 129 | 1 |
| Blandinsville, IL | $46.09 | $46.09 – $46.09 | 129 | 1 |
| Mayport, FL | $39.41 | $39.41 – $39.41 | 128 | 1 |
| Tyonek, AK | $344.14 | $343.38 – $350.85 | 128 | 2 |
| Rossville, GA | $16.35 | $16.35 – $16.35 | 128 | 1 |
| Lake Preston, SD | $119.64 | $119.64 – $119.64 | 128 | 1 |
| Kingsville, MD | $84.00 | $84.00 – $84.00 | 127 | 1 |
| Malakoff, TX | $17.16 | $17.16 – $17.16 | 127 | 1 |
| Hoyt, KS | $52.46 | $23.61 – $120.04 | 127 | 2 |
| Hico, TX | $49.20 | $49.20 – $49.20 | 127 | 1 |
| Andrews Air Force Base, MD | $33.89 | $33.89 – $33.89 | 126 | 1 |
| La Grange, CA | $22.58 | $22.58 – $22.58 | 126 | 1 |
| Sandia Park, NM | $128.23 | $128.23 – $128.23 | 126 | 1 |
| Breinigsville, PA | $49.12 | $49.12 – $49.12 | 126 | 1 |
| Sunderland, MD | $0.00 | $0.00 – $0.00 | 126 | 1 |
| Greenville, NY | $63.66 | $63.66 – $63.66 | 125 | 1 |
| Crossroads, TX | $33.49 | $33.49 – $33.49 | 125 | 1 |
| Newport Coast, CA | $0.00 | $0.00 – $0.00 | 125 | 1 |
| Glyndon, MD | $72.95 | $72.95 – $72.95 | 124 | 1 |
| Perkasie, PA | $17.37 | $14.01 – $40.78 | 124 | 3 |
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.