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 |
|---|---|---|---|---|
| Poulsboe, WA | $32.74 | $32.74 – $32.74 | 44 | 1 |
| Poca, WV | $20.72 | $20.72 – $20.72 | 43 | 1 |
| Manassas Park, VA | $45.79 | $45.79 – $45.79 | 43 | 1 |
| Warrrensville Heights, OH | $34.64 | $34.64 – $34.64 | 43 | 1 |
| Colo Spgs, CO | $141.10 | $141.10 – $141.10 | 43 | 1 |
| White Horse, SD | $623.40 | $623.40 – $623.40 | 43 | 1 |
| College Station, AR | $28.69 | $28.69 – $28.69 | 43 | 1 |
| Coulee City, WA | $41.98 | $41.98 – $41.98 | 43 | 1 |
| Oak Grove, MN | $82.92 | $82.92 – $82.92 | 43 | 1 |
| Tar Heel, NC | $17.85 | $12.22 – $21.53 | 43 | 2 |
| Fredonia, WI | $41.75 | $41.75 – $41.75 | 42 | 1 |
| Parsonsfield, ME | $89.39 | $89.39 – $89.39 | 42 | 1 |
| Buckingham, VA | $40.17 | $40.17 – $40.17 | 41 | 1 |
| New Smyrna, FL | $41.46 | $41.46 – $41.46 | 41 | 1 |
| Bolton, MS | $223.66 | $103.14 – $327.75 | 41 | 2 |
| Trooper, PA | $45.86 | $45.86 – $45.86 | 41 | 1 |
| Portsmouth, VI | $119.18 | $119.18 – $119.18 | 41 | 1 |
| Kurtistown, HI | $51.06 | $51.06 – $51.06 | 41 | 1 |
| Justin, TX | $76.94 | $76.94 – $76.94 | 41 | 1 |
| Jefferson, TN | $23.03 | $23.03 – $23.03 | 41 | 1 |
| Moody, ME | $26.48 | $22.58 – $35.89 | 41 | 2 |
| Ekwok, AK | $218.30 | $218.30 – $218.30 | 41 | 1 |
| Fairfax, MN | $63.07 | $63.07 – $63.07 | 40 | 1 |
| Phiadelphia, PA | $25.02 | $25.02 – $25.02 | 40 | 1 |
| Waterville, WA | $46.61 | $46.61 – $46.61 | 40 | 1 |
| Radium Springs, NM | $22.28 | $22.28 – $22.28 | 40 | 1 |
| Ch, SC | $52.87 | $52.87 – $52.87 | 40 | 1 |
| Valley Falls, NY | $141.50 | $141.50 – $141.50 | 40 | 1 |
| Bloomingburg, NY | $50.79 | $50.79 – $50.79 | 40 | 1 |
| Sackets Harbor, NY | $31.16 | $31.16 – $31.16 | 40 | 1 |
| Uppr Marlboro, MD | $131.63 | $131.63 – $131.63 | 40 | 1 |
| Montauk, NY | $125.57 | $78.81 – $150.75 | 40 | 2 |
| Cedarville, MI | $55.70 | $55.70 – $55.70 | 40 | 1 |
| Greenley, CO | $57.56 | $57.56 – $57.56 | 40 | 1 |
| Michigan, MI | $105.07 | $105.07 – $105.07 | 40 | 1 |
| New Holstein, WI | $13.92 | $13.92 – $13.92 | 40 | 1 |
| Table Grove, IL | $0.00 | $0.00 – $0.00 | 40 | 1 |
| Londonberry, NH | $29.70 | $29.70 – $29.70 | 40 | 1 |
| Walnut Cove, NC | $34.47 | $34.47 – $34.47 | 40 | 1 |
| North Versailles, PA | $45.59 | $22.33 – $60.13 | 39 | 2 |
| Altooona, PA | $0.00 | $0.00 – $0.00 | 39 | 1 |
| Waccabuc, NY | $144.01 | $144.01 – $144.01 | 39 | 1 |
| Tangier, VA | $38.23 | $38.23 – $38.23 | 39 | 1 |
| Fort Jackson, SC | $30.90 | $30.90 – $30.90 | 39 | 1 |
| Argyle, WI | $50.34 | $50.34 – $50.34 | 39 | 1 |
| Indianola, NE | $97.68 | $97.68 – $97.68 | 39 | 1 |
| Center, ND | $115.69 | $115.69 – $115.69 | 39 | 1 |
| Fort Wright, KY | $14.32 | $14.32 – $14.32 | 39 | 1 |
| Brighton, NY | $47.55 | $47.55 – $47.55 | 38 | 1 |
| Waterloo, IN | $74.91 | $74.91 – $74.91 | 38 | 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.