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 |
|---|---|---|---|---|
| Great River, NY | $52.96 | $52.96 – $52.96 | 65 | 1 |
| Suite B200, KY | $45.00 | $45.00 – $45.00 | 64 | 1 |
| Cape May Court, NJ | $1.88 | $1.88 – $1.88 | 64 | 1 |
| Wauneta, NE | $119.76 | $119.76 – $119.76 | 64 | 1 |
| Morrill, NE | $90.83 | $90.83 – $90.83 | 64 | 1 |
| Grandview, TX | $5.48 | $5.48 – $5.48 | 64 | 1 |
| Eynon, PA | $37.41 | $37.41 – $37.41 | 64 | 1 |
| Cotter, AR | $16.84 | $16.84 – $16.84 | 63 | 1 |
| Kindred, FL | $15.78 | $15.78 – $15.78 | 63 | 1 |
| Sherrill, NY | $58.45 | $58.45 – $58.45 | 63 | 1 |
| Newton, GA | $63.23 | $63.23 – $63.23 | 63 | 1 |
| Lakefield, MN | $33.32 | $33.32 – $33.32 | 62 | 1 |
| Melrose Park, PA | $40.35 | $40.35 – $40.35 | 61 | 1 |
| Lime Springs, IA | $0.00 | $0.00 – $0.00 | 61 | 1 |
| Linden, MI | $84.84 | $84.84 – $84.84 | 60 | 1 |
| Whiteman Air Force Base, MO | $118.55 | $118.55 – $118.55 | 60 | 1 |
| Mount Tabor, NJ | $92.10 | $92.10 – $92.10 | 60 | 1 |
| Franksville, WI | $143.56 | $143.56 – $143.56 | 60 | 1 |
| Blessing, TX | $66.03 | $66.03 – $66.03 | 60 | 1 |
| Waterboro, ME | $212.72 | $212.72 – $212.72 | 59 | 1 |
| Chebanse, IL | $53.98 | $53.98 – $53.98 | 59 | 1 |
| Lantana, TX | $4.58 | $4.58 – $4.58 | 59 | 1 |
| Centerville, MO | $15.29 | $15.29 – $15.29 | 59 | 1 |
| Roberstdale, AL | $16.24 | $16.24 – $16.24 | 59 | 1 |
| Onsted, MI | $0.00 | $0.00 – $0.00 | 59 | 1 |
| Sundance, WY | $1.58 | $0.00 – $1.98 | 59 | 2 |
| Beecher, IL | $13.45 | $13.45 – $13.45 | 59 | 1 |
| District Of Columbia, DC | $118.12 | $118.12 – $118.12 | 59 | 1 |
| White Castle, LA | $0.00 | $0.00 – $0.00 | 59 | 1 |
| Oxford, NY | $109.10 | $109.10 – $109.10 | 59 | 1 |
| Mill Hall, PA | $8.87 | $1.21 – $33.50 | 59 | 2 |
| Wasilla, AL | $93.93 | $93.93 – $93.93 | 59 | 1 |
| Newton Upper Falls, MA | $49.92 | $49.92 – $49.92 | 59 | 1 |
| Pearcy, AR | $35.74 | $23.89 – $39.78 | 59 | 2 |
| Cable, OH | $34.96 | $34.96 – $34.96 | 59 | 1 |
| Trenton, SC | $79.94 | $79.94 – $79.94 | 58 | 1 |
| Onalaska, WA | $0.00 | $0.00 – $0.00 | 58 | 1 |
| Shingle Springs, CA | $384.23 | $384.23 – $384.23 | 58 | 1 |
| Flagler Beach, FL | $42.06 | $42.06 – $42.06 | 58 | 1 |
| Lovettsville, VA | $53.99 | $53.99 – $53.99 | 58 | 1 |
| Hitchcock, TX | $32.07 | $32.07 – $32.07 | 57 | 1 |
| Biscayne Park, FL | $6.64 | $6.64 – $6.64 | 57 | 1 |
| Holden, ME | $7.68 | $7.68 – $7.68 | 57 | 1 |
| Blair, WI | $17.42 | $17.42 – $17.42 | 57 | 1 |
| Sea Bright, NJ | $31.03 | $31.03 – $31.03 | 56 | 1 |
| Wellington, TX | $67.43 | $21.36 – $219.80 | 56 | 2 |
| Blufield, VA | $4.07 | $4.07 – $4.07 | 56 | 1 |
| Bainbridge Is, WA | $53.40 | $53.40 – $53.40 | 56 | 1 |
| Mc Cordsville, IN | $0.00 | $0.00 – $0.00 | 56 | 1 |
| Stewardson, IL | $55.56 | $55.56 – $55.56 | 56 | 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.