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 |
|---|---|---|---|---|
| New Frankin, WI | $39.29 | $39.29 – $39.29 | 91 | 1 |
| Mineral, VA | $47.05 | $47.05 – $47.05 | 91 | 1 |
| Wilmar, MN | $68.36 | $68.36 – $68.36 | 91 | 1 |
| Longs, SC | $3.11 | $3.11 – $3.11 | 91 | 1 |
| Auburn, MI | $43.75 | $43.75 – $43.75 | 91 | 1 |
| Carney'S Point, NJ | $12.39 | $12.39 – $12.39 | 90 | 1 |
| Bull Shoals, AR | $41.31 | $41.31 – $41.31 | 90 | 1 |
| Rock Spring, GA | $23.89 | $23.89 – $23.89 | 89 | 1 |
| Stanley, KS | $69.13 | $69.13 – $69.13 | 89 | 1 |
| Brookeland, TX | $29.75 | $29.75 – $29.75 | 89 | 1 |
| Cromwell, MN | $63.83 | $63.83 – $63.83 | 89 | 1 |
| Battle Creek, NE | $36.83 | $36.83 – $36.83 | 89 | 1 |
| Mills, WY | $37.36 | $37.36 – $37.36 | 88 | 1 |
| Port Austin, MI | $8.40 | $8.40 – $8.40 | 88 | 1 |
| Savannah, TX | $6.89 | $6.89 – $6.89 | 88 | 1 |
| St.Michael, AK | $436.14 | $422.98 – $444.04 | 88 | 2 |
| Scottdale, GA | $47.23 | $47.23 – $47.23 | 87 | 1 |
| Roxie, MS | $40.48 | $40.48 – $40.48 | 87 | 1 |
| Millerton, NY | $53.44 | $53.44 – $53.44 | 87 | 1 |
| Grafton, OH | $8.17 | $8.17 – $8.17 | 87 | 1 |
| West Salem, WI | $30.16 | $30.16 – $30.16 | 87 | 1 |
| Moultonborough, NH | $37.35 | $27.70 – $39.60 | 86 | 3 |
| Centre Hall, PA | $0.00 | $0.00 – $0.00 | 86 | 1 |
| Bolivar, NY | $30.38 | $30.38 – $30.38 | 86 | 1 |
| Wolcott, VT | $0.00 | $0.00 – $0.00 | 86 | 1 |
| Hickam Afb, HI | $101.62 | $101.62 – $101.62 | 86 | 1 |
| Southern Shores, NC | $14.66 | $14.66 – $14.66 | 86 | 1 |
| Cincinnat, OH | $158.05 | $158.05 – $158.05 | 86 | 1 |
| Jamestown, MI | $55.79 | $55.79 – $55.79 | 86 | 1 |
| Cranberry, PA | $22.49 | $22.49 – $22.49 | 86 | 1 |
| Saint Clarisville, OH | $35.12 | $35.12 – $35.12 | 85 | 1 |
| Edwards, NY | $95.67 | $95.67 – $95.67 | 85 | 1 |
| Fryeburg, ME | $90.00 | $41.28 – $117.97 | 85 | 2 |
| Setauket- East Setauket, NY | $102.63 | $102.63 – $102.63 | 85 | 1 |
| Caroilina, PR | $61.83 | $61.83 – $61.83 | 84 | 1 |
| Bird City, KS | $129.04 | $129.04 – $129.04 | 84 | 1 |
| Orchard Lake, MI | $49.34 | $49.34 – $49.34 | 84 | 1 |
| Lake Delton, WI | $2.05 | $2.05 – $2.05 | 83 | 1 |
| Lula, GA | $29.38 | $29.38 – $29.38 | 83 | 1 |
| Belleville, NE | $42.13 | $42.13 – $42.13 | 83 | 1 |
| Cochiti Pueblo, NM | $477.66 | $477.66 – $477.66 | 83 | 1 |
| Pine City, NY | $90.98 | $90.98 – $90.98 | 83 | 1 |
| San Leando, CA | $0.00 | $0.00 – $0.00 | 83 | 1 |
| Gassville, AR | $51.47 | $51.47 – $51.47 | 83 | 1 |
| Romulus, NY | $69.65 | $69.65 – $69.65 | 82 | 1 |
| Clarks Green, PA | $26.86 | $26.86 – $26.86 | 82 | 1 |
| Casselton, ND | $95.82 | $95.82 – $95.82 | 82 | 1 |
| Central Village, CT | $16.17 | $16.17 – $16.17 | 82 | 1 |
| Thayne, WY | $63.21 | $59.36 – $65.28 | 82 | 3 |
| Croton Falls, NY | $101.66 | $101.66 – $101.66 | 82 | 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.