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 |
|---|---|---|---|---|
| Islesboro, ME | $7.09 | $7.09 – $7.09 | 124 | 1 |
| Turtle Lake, ND | $54.08 | $54.08 – $54.08 | 124 | 1 |
| Clarkesville, GA | $447.66 | $447.66 – $447.66 | 124 | 1 |
| Fairfield, VA | $29.41 | $29.41 – $29.41 | 124 | 1 |
| Catawba, NC | $79.10 | $79.10 – $79.10 | 123 | 1 |
| Tarrant, AL | $46.07 | $46.07 – $46.07 | 123 | 1 |
| Lewis Mcchord, WA | $42.58 | $42.58 – $42.58 | 122 | 1 |
| Redding, CT | $54.11 | $23.30 – $70.31 | 122 | 3 |
| Herriman, UT | $47.56 | $41.63 – $69.46 | 122 | 2 |
| Reno, OH | $15.60 | $15.60 – $15.60 | 122 | 1 |
| W Brookfield, MA | $40.57 | $40.57 – $40.57 | 122 | 1 |
| Pellston, MI | $28.78 | $28.78 – $28.78 | 122 | 1 |
| Zieglersville, PA | $22.73 | $22.73 – $22.73 | 122 | 1 |
| Roberts, WI | $69.64 | $69.64 – $69.64 | 121 | 1 |
| Linn, KS | $68.47 | $68.47 – $68.47 | 121 | 1 |
| Elwyn, PA | $14.92 | $14.92 – $14.92 | 121 | 1 |
| Grandpraire, TX | $108.01 | $108.01 – $108.01 | 121 | 1 |
| Smithville, GA | $52.58 | $52.58 – $52.58 | 120 | 1 |
| Canyon City, OR | $0.00 | $0.00 – $0.00 | 120 | 1 |
| Waterford Works, NJ | $21.84 | $21.84 – $21.84 | 119 | 1 |
| Berry, AL | $30.21 | $30.21 – $30.21 | 119 | 1 |
| University Park, IL | $36.58 | $36.58 – $36.58 | 118 | 1 |
| Victoria, KS | $62.86 | $62.86 – $62.86 | 118 | 1 |
| Colwich, KS | $28.03 | $9.63 – $34.03 | 118 | 2 |
| Bardwell, KY | $37.70 | $37.70 – $37.70 | 118 | 1 |
| Astor, FL | $0.00 | $0.00 – $0.00 | 118 | 1 |
| Nicholson, PA | $47.48 | $47.48 – $47.48 | 118 | 1 |
| Sodus Point, NY | $14.12 | $14.12 – $14.12 | 117 | 1 |
| Montrose, MO | $85.40 | $85.40 – $85.40 | 117 | 1 |
| Crofton, NE | $59.10 | $59.10 – $59.10 | 117 | 1 |
| Joint Base Langley-Eustis, VA | $96.25 | $96.25 – $96.25 | 117 | 1 |
| Point Roberts, WA | $28.96 | $10.86 – $51.58 | 117 | 2 |
| Ridge Spring, SC | $158.55 | $158.55 – $158.55 | 116 | 1 |
| Dagsboro, DE | $4.85 | $4.85 – $4.85 | 116 | 1 |
| Greely, CO | $63.00 | $63.00 – $63.00 | 116 | 1 |
| Tuxedo Park, NY | $34.47 | $34.47 – $34.47 | 116 | 1 |
| Parksburg, PA | $48.73 | $48.73 – $48.73 | 116 | 1 |
| Wells, NV | $38.98 | $38.98 – $38.98 | 115 | 1 |
| Lansing, NC | $42.66 | $42.66 – $42.66 | 115 | 1 |
| Viola, AR | $34.49 | $34.49 – $34.49 | 115 | 1 |
| Mc Guire Afb, NJ | $75.51 | $75.51 – $75.51 | 115 | 1 |
| Jeffersontown, KY | $35.28 | $30.49 – $37.13 | 115 | 2 |
| Scio, OR | $76.57 | $76.57 – $76.57 | 114 | 1 |
| Smyrna, SC | $14.79 | $14.79 – $14.79 | 114 | 1 |
| Fountainville, PA | $82.71 | $52.81 – $92.44 | 114 | 2 |
| Keystone, CO | $8.65 | $8.65 – $8.65 | 114 | 1 |
| Mechanicsville, IA | $0.00 | $0.00 – $0.00 | 114 | 1 |
| Roc, IL | $23.84 | $23.84 – $23.84 | 114 | 1 |
| Morrisdale, PA | $0.00 | $0.00 – $0.00 | 113 | 1 |
| Lake In The Hills, IL | $25.32 | $12.52 – $32.34 | 113 | 2 |
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.