Healthcare Insights
Top 10 urgent care procedures in 2021
Urgent care has taken off in the past few years, and its growth accelerated further during the COVID-19 pandemic. Many patients prefer urgent care to other care delivery methods because of its broad treatment capacity, low cost and convenience. During the pandemic, urgent care centers also offered a common access point for care and testing related to COVID-19.
Definitive Healthcare tracks more than 8,000 codes related to urgent care procedures. See the list below for the top 10 procedures at urgent care centers in 2021.
| Rank | CPT code | Description | # total procedures | Avg charge/procedure | Explore dataset |
|---|---|---|---|---|---|
| 1 | 99213 | Office/outpatient visit established low medical decision-making 20-29 min | 9,267,522 | $174 | Explore |
| 2 | 99203 | Office/outpatient visit new low medical decision-making 30-44 min | 6,498,252 | $223 | Explore |
| 3 | 99214 | Office/outpatient established moderate medical decision-making 30-39 min | 5,463,879 | $223 | Explore |
| 4 | 87426 | Infectious agent antigen detection by immunoassay severe AQTRESPIRSYND coronavirus | 5,413,467 | $83 | Explore |
| 5 | S9083 | Urgent care center global | 4,115,484 | $234 | Explore |
| 6 | 99204 | Office/outpatient new moderate medical decision-making 45-59 min | 2,848,302 | $306 | Explore |
| 7 | 87635 | Infectious agent detection by nucleic acid SARS-COV-2 COVID-19 amplified probe technique | 2,426,733 | $115 | Explore |
| 8 | 87804 | Infectious agent antigen detection by immunoassay with direct optical observation; influenza | 1,691,239 | $41 | Explore |
| 9 | 87811 | SARS-COV-2 COVID19 with optic | 1,687,451 | $106 | Explore |
| 10 | 87880 | Infectious agent antigen detection by immunoassay with direct optical observation; streptococcus, Group A | 1,618,330 | $42 | Explore |
Fig. 1 Data is from the Definitive Healthcare ClaimsMx product for the 2021 calendar year. Data is accurate as of May 2022.
Which urgent care CPT code had the most procedures in 2021?
CPT code 99213, office/outpatient visit established low medical decision-making 20-29 min, had the most procedures with 9,267,522. Across the top 10 urgent care CPT codes, there was a total of 41,030,659 procedures and an average of 4,103,066 procedures.
The top three CPT codes, 99213, 99203 and 99214, each cover office or outpatient visits with a low to medium level of decision-making lasting under an hour. It makes sense that these codes top the list and account for over half of the top 10 procedures since urgent care intends to be quick and address a wide range of ailments.
Since COVID-19 was around for the entire year, it’s unsurprising that three CPT codes related to COVID-19 made the list: 87426, 87635 and 87811. Each describes the detection of COVID-19 through testing. Together, they account for around 23% of the top 10 procedures.
Codes concerning other viruses, particularly influenza (87804) and streptococcus (87880), also made the list.
What are the levels of medical decision-making?
There are four levels used to classify medical decision-making.
- Straightforward complexity
- Low complexity
- Moderate complexity
- High complexity
Each level is ranked by the amount of intellectual energy required to make a medical decision, with straightforward complexity being the lowest amount and high complexity being the highest amount.
What is urgent care?
Urgent care is a format of outpatient medical care that offers convenient, immediate and efficient treatment for many illnesses and injuries. While urgent care isn’t a replacement for primary care, it can be an effective substitute for emergency room care, which is often costly and time-consuming.
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