R97.20 — Elevated prostate specific antigen [PSA]
R97.20 is a billable, specific ICD-10-CM code for elevated prostate specific antigen [psa]. It is valid for submission on a claim.
Risk adjustment
R97.20 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.
Medicare coverage
R97.20 is named in 14 Medicare coverage policies — 14 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- A56287Billing and Coding: 4Kscore Test Algorithm
- A56653Billing and Coding: 4Kscore Test Algorithm
- A57152Billing and Coding: MolDX: SelectMDx for Prostate Cancer
- A57427Billing and Coding: Transrectal Ultrasound
How R97.20 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to R97.20.
- Elevated, elevation›prostate specific antigen [PSA]
Related codes at this level
Codes that share R97.2. If R97.20 is not quite right, the correct code is usually one of these.
Questions about R97.20
- Is R97.20 a billable ICD-10-CM code?
- Yes. R97.20 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does R97.20 sit in the tabular list?
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99), in the block Abnormal tumor markers (R97).