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 |
|---|---|---|---|---|
| Brighton, NY | $47.55 | $47.55 – $47.55 | 38 | 1 |
| Waterloo, IN | $74.91 | $74.91 – $74.91 | 38 | 1 |
| Benavides, TX | $9.97 | $9.97 – $9.97 | 37 | 1 |
| Cascade, CO | $68.36 | $68.36 – $68.36 | 37 | 1 |
| Large, PA | $233.06 | $233.06 – $233.06 | 37 | 1 |
| Watauga, TX | $28.34 | $28.34 – $28.34 | 37 | 1 |
| Marenisco, MI | $39.76 | $39.76 – $39.76 | 36 | 1 |
| Pulaski, IL | $0.00 | $0.00 – $0.00 | 36 | 1 |
| Bel Aire, KS | $33.45 | $33.45 – $33.45 | 36 | 1 |
| St Mary'S City, MD | $55.52 | $55.52 – $55.52 | 36 | 1 |
| Waynesboro, GA | $8.10 | $8.10 – $8.10 | 36 | 1 |
| Riegelwood, NC | $3.17 | $3.17 – $3.17 | 36 | 1 |
| Upperville, VA | $0.00 | $0.00 – $0.00 | 36 | 1 |
| Chillicoth, OH | $54.45 | $54.45 – $54.45 | 36 | 1 |
| Carol City, FL | $8.14 | $8.14 – $8.14 | 36 | 1 |
| Bovey, MN | $51.20 | $51.20 – $51.20 | 35 | 1 |
| Elma, IA | $0.00 | $0.00 – $0.00 | 35 | 1 |
| Hawkins, TX | $30.76 | $30.76 – $30.76 | 35 | 1 |
| Ghent, KY | $22.00 | $22.00 – $22.00 | 35 | 1 |
| West Stewardstown, NH | $38.65 | $38.65 – $38.65 | 35 | 1 |
| Thomaston, AL | $0.00 | $0.00 – $0.00 | 35 | 1 |
| Boscawen, NH | $21.79 | $21.79 – $21.79 | 35 | 1 |
| Butterfield, MN | $18.68 | $18.68 – $18.68 | 35 | 1 |
| Clarendon, TX | $24.90 | $24.90 – $24.90 | 34 | 1 |
| Charlestib, SC | $34.29 | $34.29 – $34.29 | 34 | 1 |
| Rose Bud, AR | $17.80 | $17.80 – $17.80 | 34 | 1 |
| Upper Saddle River, NJ | $143.97 | $143.97 – $143.97 | 34 | 1 |
| Tonalea, AZ | $427.18 | $427.18 – $427.18 | 34 | 1 |
| Loch Lynn, MD | $0.58 | $0.58 – $0.58 | 34 | 1 |
| Carlin, NV | $0.00 | $0.00 – $0.00 | 34 | 1 |
| Edwardsport, IN | $80.39 | $80.39 – $80.39 | 34 | 1 |
| Montclair Nj, NJ | $19.72 | $19.72 – $19.72 | 34 | 1 |
| Soldedad, CA | $0.00 | $0.00 – $0.00 | 34 | 1 |
| Perrysburg, NY | $95.14 | $95.14 – $95.14 | 34 | 1 |
| Buna, TX | $8.19 | $8.19 – $8.19 | 33 | 1 |
| Wayland, IA | $0.00 | $0.00 – $0.00 | 33 | 1 |
| Woodcliff Lake, NJ | $41.78 | $41.78 – $41.78 | 33 | 1 |
| Warm Springs, VA | $16.00 | $16.00 – $16.00 | 33 | 1 |
| Oxford, NE | $76.91 | $76.91 – $76.91 | 33 | 1 |
| Frametown, WV | $9.23 | $9.23 – $9.23 | 33 | 1 |
| Merriville, IN | $28.32 | $28.32 – $28.32 | 33 | 1 |
| Shageluk, AK | $0.00 | $0.00 – $0.00 | 33 | 1 |
| Cowen, WV | $44.49 | $44.49 – $44.49 | 33 | 1 |
| North Apollo, PA | $36.90 | $13.35 – $56.53 | 33 | 2 |
| Crane, TX | $0.91 | $0.91 – $0.91 | 33 | 1 |
| Chateaugay, NY | $108.78 | $108.78 – $108.78 | 32 | 1 |
| Munice, IN | $76.83 | $76.83 – $76.83 | 32 | 1 |
| Arlington, MD | $108.50 | $108.50 – $108.50 | 32 | 1 |
| Stanhope, NJ | $104.05 | $104.05 – $104.05 | 32 | 1 |
| Urbana, MO | $98.79 | $98.79 – $98.79 | 32 | 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.