R97.20 — Elevated prostate specific antigen [PSA]
Is R97.20 billable?
Yes — R97.20 is billable for FY2027. R97.20 is a valid, billable ICD-10-CM code at the highest level of specificity in its branch. R97.20 may be submitted for encounters from October 1, 2026 through September 30, 2027.
R97.20 at a glance
| Code | R97.20 |
|---|---|
| Description | Elevated prostate specific antigen [PSA] |
| Billable | Yes |
| Code set | ICD-10-CM FY2027 |
| Valid for encounters | October 1, 2026 – September 30, 2027 |
What Medicare edits apply to R97.20?
The Medicare Code Editor screens inpatient claims before they are grouped. These edits name R97.20 directly.
CMS does not consider this code, on its own, sufficient justification for admission to an acute care hospital when reported as the principal diagnosis.
Which MS-DRGs does R97.20 group to?
R97.20 sits in MDC 23 and helps define the logic of 2 MS-DRGs (version 44, FY2027). Which one a stay actually groups to also depends on procedures and secondary diagnoses.
- 947Signs and Symptoms with MCCmedical
- 948Signs and Symptoms without MCCmedical
How is R97.20 listed in the Alphabetic Index?
These are the routes through the Alphabetic Index that lead to R97.20. They show the wording a clinician may have documented, which often differs from the Tabular description.
- Elevated, elevation › prostate specific antigen [PSA]
Excludes2 — not included here — inherited from Chapter 18
The conditions below are not part of R97.20, but a patient may have both at the same time. When documentation supports it, R97.20 and the excluded code may both be reported.
How long has R97.20 existed?
R97.20 first appears in FY2018 (FY2017 is not available, so it may have appeared then).
Derived from the official order files for FY2016–FY2026. FY2017 and FY2020 publish no order file, so those years are not covered.