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 |
|---|---|---|---|---|
| Medicine Park, OK | $0.00 | $0.00 – $0.00 | 25 | 1 |
| Millington, MD | $99.17 | $99.17 – $99.17 | 25 | 1 |
| Beesleys Point, NJ | $36.34 | $36.34 – $36.34 | 25 | 1 |
| Meszuite, TX | $0.00 | $0.00 – $0.00 | 25 | 1 |
| Georgetown, PA | $45.58 | $45.58 – $45.58 | 25 | 1 |
| Sherborn, MA | $23.83 | $23.83 – $23.83 | 25 | 1 |
| Centuria, WI | $66.74 | $66.74 – $66.74 | 25 | 1 |
| Moran, WY | $61.91 | $61.91 – $61.91 | 25 | 1 |
| Roulette, PA | $6.08 | $6.08 – $6.08 | 25 | 1 |
| East Bernard, TX | $97.62 | $97.62 – $97.62 | 25 | 1 |
| Fayardo, PR | $56.23 | $56.23 – $56.23 | 24 | 1 |
| Losantville, IN | $18.31 | $18.31 – $18.31 | 24 | 1 |
| Richford, NY | $6.48 | $6.48 – $6.48 | 24 | 1 |
| Gibsland, LA | $0.00 | $0.00 – $0.00 | 24 | 1 |
| Saint James City, FL | $32.71 | $32.71 – $32.71 | 24 | 1 |
| Westlake Vlg, CA | $0.00 | $0.00 – $0.00 | 24 | 1 |
| Washington Crossing, PA | $34.10 | $34.10 – $34.10 | 24 | 1 |
| Mooresville, MO | $63.30 | $63.30 – $63.30 | 24 | 1 |
| Vinings, GA | $33.39 | $33.39 – $33.39 | 24 | 1 |
| Prudhoe Bay, AK | $0.00 | $0.00 – $0.00 | 23 | 1 |
| Roslyn Hts, NY | $8.19 | $8.19 – $8.19 | 23 | 1 |
| Brooklyn, NM | $82.17 | $82.17 – $82.17 | 23 | 1 |
| Edgewood, WA | $91.12 | $91.12 – $91.12 | 23 | 1 |
| Yellowstone National Park, WY | $36.34 | $36.34 – $36.34 | 23 | 1 |
| Dorris, CA | $0.00 | $0.00 – $0.00 | 22 | 1 |
| Hardwick, NJ | $35.53 | $35.53 – $35.53 | 22 | 1 |
| Booker, TX | $0.00 | $0.00 – $0.00 | 22 | 1 |
| Broadview, IL | $11.74 | $11.74 – $11.74 | 22 | 1 |
| Virginia Gardens, FL | $7.21 | $7.21 – $7.21 | 22 | 1 |
| Monterrey Park, CA | $142.30 | $142.30 – $142.30 | 22 | 1 |
| Monona, IA | $3.34 | $3.34 – $3.34 | 22 | 1 |
| Big Creek, KY | $18.97 | $18.97 – $18.97 | 22 | 1 |
| Alexis, IL | $56.59 | $56.59 – $56.59 | 22 | 1 |
| Garrett, KY | $46.33 | $46.33 – $46.33 | 21 | 1 |
| West Yellowstone, MT | $68.23 | $68.23 – $68.23 | 21 | 1 |
| New Rockford, ND | $654.00 | $654.00 – $654.00 | 21 | 1 |
| New, NY | $106.66 | $106.66 – $106.66 | 21 | 1 |
| Brooklandville, MD | $67.69 | $67.69 – $67.69 | 21 | 1 |
| Cave Spring, GA | $43.86 | $43.86 – $43.86 | 21 | 1 |
| North Tustin, CA | $318.75 | $318.75 – $318.75 | 21 | 1 |
| New Harbor, ME | $20.33 | $20.33 – $20.33 | 20 | 1 |
| Cunningham, KS | $294.78 | $294.78 – $294.78 | 20 | 1 |
| Garden City, MO | $15.95 | $15.95 – $15.95 | 20 | 1 |
| Double Oak, TX | $23.93 | $23.93 – $23.93 | 20 | 1 |
| Willamsburgh, VA | $76.92 | $76.92 – $76.92 | 20 | 1 |
| Poblado Rosario, PR | $0.00 | $0.00 – $0.00 | 20 | 1 |
| Clarkson, NE | $158.35 | $158.35 – $158.35 | 20 | 1 |
| Howells, NE | $144.06 | $144.06 – $144.06 | 20 | 1 |
| Glen Burne, MD | $66.66 | $66.66 – $66.66 | 20 | 1 |
| Creedmore, NC | $70.05 | $70.05 – $70.05 | 20 | 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.