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Objective:
In the past decade, there has been a marked increase in urgent care facilities across the United States, with many staffed by mid-level advanced practice providers (APPs), such as nurse practitioners and physician assistants. This study quantifies recent trends in urgent care visits by physicians and APPs, as well as utilization of advanced imaging services, including CT and MR, in urgent care settings.

Materials and Methods:
The CMS Physician/Supplier Public Summary File was used to extract all records from urgent care facilities from 2013 to 2020. The number of urgent care visits each year was calculated by totaling the number of evaluation/management codes. Using the Neiman Imaging Types of Service classification system, all imaging related codes that included the professional component were then further extracted from this list of claims, and then further stratified by modality. The utilization rate of imaging services overall and by imaging modality were calculated. Compound annual growth rates (CAGR) and a Pearson correlation coefficient with associated p value were calculated, with <em>P</em> < 0.05 considered to be significant.

Results:
Urgent care visit overall volume was 2,028,899 in 2013 and 4,247,223 in 2019 (CAGR 13.1%). MD staffed urgent care visit volume was 1,746,491 in 2013 and 2,058,995 in 2019 (CAGR 2.8%). APP staffed urgent care visit volume was 282,408 in 2013 and 2,188,228 in 2019 (CAGR 40.7%). Advanced imaging volume in urgent care facilities was 2,654 in 2013 and 13,111 in 2019 (CAGR 30.5%). The utilization rate of advanced imaging examinations per 10,000 urgent care visits was 13.08 in 2013 and 30.87 in 2019 (CAGR 15.4%). From 2013 to 2019, increases in volume of advanced imaging in the urgent care setting correlated with overall urgent care visit volume (r = 0.99, p = 0.00019), MD staffed urgent care visits (r = 0.85, p = 0.02), and APP staffed urgent care visits (r = 0.99, p = < 0.00001). In 2020, volume of advanced imaging in the urgent care setting was 11,662 (CAGR - 11.1%), MD staffed urgent care visit volume was 1,989,268 (CAGR -3.4%), APP staffed urgent care visit volume was 2,417,149 (CAGR 10.5%), total imaging volume was 395,486 (CAGR -30.9%), and utilization rate of advanced imaging examinations per 10,000 urgent care visits was 26.5 (CAGR - 14.2%).

Conclusion:
Significant increases in the use of advanced imaging, such as CT and MR, have occurred in the urgent care setting for US Medicare beneficiaries. These increases in use of advanced imaging correlate with increases in staffing of urgent care visits by advanced practice providers and raise potential concern for unwarranted variations in the use of advanced imaging services. In 2020, there was a decrease in CT and MR volume, despite increases in urgent care visits, perhaps due to shift of focus to acutely ill patients with COVID-19 during the early phase of the COVID-19 global pandemic. Further investigation is needed to better understand causes of recent increases in utilization of advanced imaging in the urgent care setting.