For its first 8 miles (13 km), it runs parallel to a former line of the Norfolk & Western railroad.

[4] Because of its proximity to the abandoned rail line, Iowa 202 follows an unusual path; heading northeast, turning north, and then turning northwest into Appanoose County.

It continues to the northwest for 5 miles (8.0 km) before going through an ess curve which points Iowa 202 to the north towards Moulton.

[1] The section from Iowa Highway 2 to Moulton was designated in 1920 as Primary Road No.

In 1938, Iowa 142 extended south to the Missouri state line.