R97.20Elevated prostate specific antigen [PSA]

R97.20 is the ICD-10-CM diagnosis code for elevated prostate specific antigen [PSA]. It belongs to category R97 (abnormal tumor markers), block R97 (abnormal tumor markers) and chapter 18 (symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified). It is billable, so it can be reported on its own for dates of service from October 1, 2026 through September 30, 2027.

Within R97.2 (elevated prostate specific antigen [PSA]), R97.20 is specifically for elevated prostate specific antigen [PSA]. Related codes cover Rising PSA following treatment for malignant neoplasm of prostate (R97.21).

It is not a CC or MCC, so as a secondary diagnosis it doesn't change the MS-DRG severity level.

In MS-DRG v44.0, it is part of the grouping logic for DRG 947 (Signs and Symptoms with MCC, relative weight 1.261) and DRG 948 (Signs and Symptoms without MCC, relative weight 0.7835), in MDC 23 (Factors Influencing Health Status and Other Contacts with Health Services), as a principal or secondary diagnosis. The DRG a claim lands in depends on the principal diagnosis, procedures and any CC/MCC secondary diagnoses.

The Medicare Code Editor expects this diagnosis only for patients age 15 through 124.

When it is the principal diagnosis, Medicare considers it a questionable reason for an inpatient admission, so claims may be reviewed.

It is on the CMS list of diagnoses consistent only with male patients (the sex-conflict edit itself was retired in FY2025).

It was added in FY2017, effective October 1, 2016.

Before ICD-10, this condition was coded in ICD-9-CM as 790.93 (elevated prostate specific antigen [PSA]).