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The share of the procedures provided in urgent care (UC) centers submitted on commercial insurance claims grew 207% from 2013 to 2022, according to an in-depth index report from nonprofit claims-data analysis organization FAIR Health. Teasing out single-year growth, utilization of urgent care centers increased 43% from 2021 to 2022. Growth of these “claim lines”—essentially individual procedures listed on insurance claims—echoes the robust growth in the number of urgent care clinics serving the nation overall, as we reported recently in JUCM. FAIR Health also compared median prices and payment for the most common UC procedure: CPT 99204, which is the code for a new patient office or outpatient visit of 45-59 minutes.

CPT 99204:

  • Traditional office visit—$352 charged, $183 allowed
  • Urgent care—$343 charged, $174 allowed
  • Retail clinic—$293 charged, $149 allowed

In 2022, the top states with urgent care center usage as a percentage of all medical claim lines were New Mexico, Hawaii, Maryland, New York, and New Jersey. The states with the lowest urgent care center usage were North Dakota, Iowa, Nebraska, Arkansas, and Massachusetts.

Individuals between 31 and 40 years old were the highest utilizers of urgent care, and acute respiratory diseases/infections was UC’s most common diagnostic category in 2022.

Diagnostic categories for urgent care:

  • Acute respiratory diseases and infections—21%
  • Injury to body—8%
  • COVID-19—7%
  • Urinary tract infection—6%
  • Ear infections and issues—5%

Everyone else: FAIR Health collects more than 3 billion claim records a year from commercial insurers. Its analysis also found retail clinic utilization increased 202% from 2021 to 2022, and utilization of emergency departments increased 138%.

Payer Stats Reveal Urgent Care Utilization Up 207%