U.S. Route 220 Alternate (US 220 Alt), established in 1979, is an 27.5-mile (44.3 km) route that follows the old US 220 route through Candor, Biscoe and Star. In 1997, it was extend further north through Seagrove to its current terminus near Ulah. In 2008, the US 220 Alt was temporary extended south 7.9-mile (12.7 km) to NC 73, while mainline US 220 was on new freeway filling in for Future I-73/I-74; In 2013, mainline US 220 was moved back on that section. Predominantly a two-lane rural highway, it begins at exit 41 interchange from I-73/I-74/US 220 and ends at US 220 Bus, just 200 feet (61 m) from exit 68.
End of US 220 Alt at US 220 Bus, connecting to nearby I-73/I-74/US 220
U.S. Route 220 Business (US 220 Bus) was established in 1966 when mainline US 220 was rerouted onto new freeway bypass from south of Ulah to Vision Drive, in Asheboro. In 1972, US 220 Bus replaced some of the mainline along Vision Drive as new freeway was built further north towards US 311. In 1974, US 220 Bus was removed from Vision Drive and continued north along the old mainline route, through Randleman, to Level Cross. In 1982, US 220 Bus was adjusted at Level Cross, replacing some of the mainline to its current terminus with US 220 interchange. US 220 Bus is two-lane along its routing outside Asheboro and three to four-lane in Asheboro. The entire route is in Randolph County.
U.S. Route 220 Business begins at an interchange two miles south of Rocky Mount as South Main Street. The street continues north through residential neighborhoods as it passes Franklin Memorial Hospital and the Franklin County Courthouse in downtown Rocky Mount. The route continues north as Main Street and intersects with Virginia State Route 40 (Franklin St and Pell Avenue). The street becomes North Main Street as it continues north through town. North Main St intersects with State Route 919 just before the final interchange with US 220.
In the 1930s and 40s, the Bonsack to Cloverdale route was part of VA 114 until it was downgraded to SR 604 in April 1944. In the 1990s, the section from Bonsack to Cloverdale was widened to four lanes and it serves as a bypass for US 460 seeking to avoid Roanoke traffic congestion.
Previously, the Rocky Mount bypass was designated as US 220 Alternate from its construction in 1960-61 until it was changed to US 220 Bypass between 1968-70.
U.S. Route 220 Truck is a southbound-only truck route used to bypass the exit ramp from eastbound I-68 to southbound US 220 at Interchange 42, which carries a truck and bus prohibition due to the steep grade. The restricted traffic exits eastbound I-68 at Interchange 40 and follows US 220 Truck, which follows MD 658 (Vocke Road) and then MD 53 south to US 220 in Cresaptown.
U.S. Route 220 Business is a 12-mile (19 km) route following the original alignment of its parent. In 1973, US 220 became a freeway between Bedford and Altoona, Pennsylvania, and the old tract of the route near Bedford became a business loop. Currently, US 220 has been partnered with Interstate 99; however, the freeway segment south of the Pennsylvania Turnpike is currently not yet part of the interstate system, which may or may not have an impact on the future status of this road. South of the borough, the route winds over the hilly approach to the town at much steeper grades than does the freeway. It ten reaches several stoplights as it serves as a north-south main street. After exciting the municipality, it briefly becomes four lanes as it accommodates a variety of travel services at the interchanges with the Turnpike and I-99. Travelling north, the route flattens out, before meeting US 220 at I-99 Exit 3.
U.S. Route 220 Business is a 37-mile (60 km) route following the original alignment of its parent. The route begins at Exit 13 of Interstate 99, in the southernmost point of Blair County, Pennsylvania. After travelling over a largely rural two-lane segment, it briefly becomes four lanes as it enters metropolitan Altoona; the highway then spends nearly a mile co-signed with two-lane U.S. Route 22. Afterward, it becomes Plank Road between Hollidaysburg and Altoona, feature four-lanes, a center turning lane, and a copious commercial development. Eventually the route becomes the more suburban Pleasant Valley Boulevard, and it transitions to a two-laner before leaving the urban area. A cosign with Pennsylvania Route 764 occurs, as the route travels toward Tyrone, through which it serves as a narrow main street. After heading through several more small towns, the route rejoins I-99 at Exit 52.
U.S. Route 220 Business (US 220 Bus) was established in 2008 as a temporary route, while mainline US 220 was on new freeway filling in for Future I-73/I-74. At or near NC 73, it would continue north as US 220 Alt. In 2013, mainline US 220 was moved back onto its original route through Ellerbe, deleting the business loop.