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 |
|---|---|---|---|---|
| Fayette, OH | $29.25 | $29.25 – $29.25 | 12 | 1 |
| Darrow, LA | $85.72 | $85.72 – $85.72 | 12 | 1 |
| England, AR | $0.00 | $0.00 – $0.00 | 12 | 1 |
| Abbotsford, WI | $53.38 | $53.38 – $53.38 | 12 | 1 |
| Tatitlek, AK | $148.01 | $148.01 – $148.01 | 12 | 1 |
| Fortson, GA | $88.92 | $88.92 – $88.92 | 12 | 1 |
| N Cape May, NJ | $52.63 | $52.63 – $52.63 | 12 | 1 |
| Jenison, MI | $71.66 | $71.66 – $71.66 | 12 | 1 |
| Bell Canyon, CA | $64.87 | $64.87 – $64.87 | 12 | 1 |
| Eagleville, MO | $58.12 | $58.12 – $58.12 | 12 | 1 |
| St Louisville, OH | $14.54 | $14.54 – $14.54 | 12 | 1 |
| S Sioux City, NE | $318.75 | $318.75 – $318.75 | 12 | 1 |
| Salt Rock, WV | $0.00 | $0.00 – $0.00 | 12 | 1 |
| Vannuys, CA | $83.08 | $83.08 – $83.08 | 12 | 1 |
| Sangabriel, CA | $18.00 | $18.00 – $18.00 | 12 | 1 |
| Gray Court, SC | $81.89 | $81.89 – $81.89 | 12 | 1 |
| S Pasadena, CA | $82.61 | $82.61 – $82.61 | 12 | 1 |
| Wilkesbarre, PA | $43.42 | $43.42 – $43.42 | 12 | 1 |
| Arnold, PA | $20.67 | $20.67 – $20.67 | 12 | 1 |
| Bee Caves, TX | $41.05 | $41.05 – $41.05 | 12 | 1 |
| Washington, GA | $79.21 | $79.21 – $79.21 | 12 | 1 |
| Edgar, NE | $107.54 | $107.54 – $107.54 | 12 | 1 |
| Mcconnell Air Force Base, KS | $3.45 | $3.45 – $3.45 | 12 | 1 |
| La Grande, Or 97850, OR | $81.74 | $81.74 – $81.74 | 12 | 1 |
| Higley, AZ | $9.17 | $9.17 – $9.17 | 12 | 1 |
| Anthony, FL | $22.88 | $22.88 – $22.88 | 12 | 1 |
| Champmanville, WV | $39.04 | $39.04 – $39.04 | 12 | 1 |
| Shell Beach, CA | $0.00 | $0.00 – $0.00 | 12 | 1 |
| Armarillo, TX | $68.57 | $68.57 – $68.57 | 12 | 1 |
| Ft Monmouth, NJ | $23.13 | $23.13 – $23.13 | 12 | 1 |
| Alviso, CA | $24.36 | $24.36 – $24.36 | 12 | 1 |
| Chgo, IL | $72.03 | $72.03 – $72.03 | 12 | 1 |
| Hernando, FL | $376.47 | $376.47 – $376.47 | 12 | 1 |
| Coleman, MI | $84.20 | $84.20 – $84.20 | 12 | 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.