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 |
|---|---|---|---|---|
| Casselton, ND | $95.82 | $95.82 – $95.82 | 82 | 1 |
| Glenmoore, PA | $89.64 | $89.64 – $89.64 | 81 | 1 |
| Chapel Hill, ND | $31.50 | $31.50 – $31.50 | 81 | 1 |
| North Pole, AK | $95.34 | $95.34 – $95.34 | 81 | 1 |
| Davenport, VA | $49.78 | $49.78 – $49.78 | 81 | 1 |
| Ringoes, NJ | $49.52 | $49.52 – $49.52 | 81 | 1 |
| Hope Hull, AL | $46.91 | $46.91 – $46.91 | 81 | 1 |
| Ruston, WA | $134.94 | $134.94 – $134.94 | 81 | 1 |
| Farley, IA | $34.49 | $34.49 – $34.49 | 81 | 1 |
| China Spring, TX | $18.26 | $18.26 – $18.26 | 81 | 1 |
| Cape May Ch, NJ | $43.08 | $43.08 – $43.08 | 80 | 1 |
| Moontownship, PA | $39.29 | $39.29 – $39.29 | 80 | 1 |
| Merrero, LA | $16.49 | $16.49 – $16.49 | 80 | 1 |
| Cooperstown, ND | $96.92 | $90.91 – $127.43 | 79 | 2 |
| Friona, TX | $33.88 | $33.88 – $33.88 | 79 | 1 |
| Whitewater, KS | $4.90 | $4.90 – $4.90 | 79 | 1 |
| New Hyde Pk, NY | $52.82 | $52.82 – $52.82 | 79 | 1 |
| Bloomingdale, NY | $74.21 | $74.21 – $74.21 | 79 | 1 |
| White Marsh, VA | $45.62 | $45.62 – $45.62 | 79 | 1 |
| Faribanks, AK | $69.35 | $69.35 – $69.35 | 78 | 1 |
| Garysburg, NC | $0.00 | $0.00 – $0.00 | 78 | 1 |
| Saint Marys, KS | $24.99 | $0.00 – $41.46 | 78 | 2 |
| Sandy Spgs, GA | $13.70 | $13.70 – $13.70 | 78 | 1 |
| Hazelton, PA | $37.30 | $37.30 – $37.30 | 78 | 1 |
| Vesper, WI | $28.52 | $28.52 – $28.52 | 78 | 1 |
| Sully, IA | $20.96 | $20.96 – $20.96 | 77 | 1 |
| Cedarhust, NY | $90.07 | $90.07 – $90.07 | 77 | 1 |
| Cherry Valley, AR | $0.00 | $0.00 – $0.00 | 77 | 1 |
| Summersville, MO | $65.79 | $65.79 – $65.79 | 77 | 1 |
| Fort Monmouth, NJ | $76.93 | $76.93 – $76.93 | 76 | 1 |
| West Chester, IL | $42.89 | $42.89 – $42.89 | 76 | 1 |
| Greene, ME | $29.30 | $15.98 – $72.21 | 76 | 2 |
| Patton, PA | $19.87 | $13.48 – $42.05 | 76 | 2 |
| Oaks, PA | $21.47 | $9.98 – $65.17 | 76 | 3 |
| Lathrop, MO | $42.17 | $42.17 – $42.17 | 76 | 1 |
| Christiana, TN | $34.58 | $34.58 – $34.58 | 76 | 1 |
| Richmond, IL | $0.00 | $0.00 – $0.00 | 76 | 1 |
| Morris, NY | $77.48 | $77.48 – $77.48 | 76 | 1 |
| Mountain City, GA | $53.54 | $53.54 – $53.54 | 75 | 1 |
| Norwood, NJ | $3.58 | $2.62 – $3.78 | 75 | 2 |
| Chenega Bay, AK | $377.59 | $148.01 – $421.32 | 75 | 2 |
| Sicklerville, PA | $6.35 | $6.35 – $6.35 | 75 | 1 |
| Springtown, TX | $0.48 | $0.00 – $0.60 | 75 | 2 |
| New Alexandria, PA | $39.64 | $39.64 – $39.64 | 74 | 1 |
| Wilmot, AR | $2.11 | $0.00 – $2.56 | 74 | 2 |
| Lanesboro, MN | $25.33 | $25.33 – $25.33 | 74 | 1 |
| Malad, ID | $4.69 | $4.69 – $4.69 | 74 | 1 |
| Adams Center, NY | $59.10 | $59.10 – $59.10 | 74 | 1 |
| Star, NC | $2.03 | $2.03 – $2.03 | 74 | 1 |
| Saunderstown, RI | $59.58 | $59.58 – $59.58 | 73 | 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.