ICD-10 · PDGM grouping
R97 Abnormal tumor markers
All 5 codes in the R97 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
5
Can lead a claim
0
Cannot lead a claim
5
What CMS assigns to R97
None of the 5 codes is assigned a clinical group. None of the 5 is assigned a comorbidity subgroup. None can lead a claim.
Every code in R97
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| R97.0 | Elevated carcinoembryonic antigen [CEA] | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| R97.1 | Elevated cancer antigen 125 [CA 125] | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| R97.2 Elevated prostate specific antigen [PSA] | ||||
| R97.20 | Elevated prostate specific antigen [PSA] | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| R97.21 | Rising PSA following treatment for malignant neoplasm of prostateCMS: Rising PSA fol treatment for malignant neoplasm of prostate | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
| R97.8 | Other abnormal tumor markers | Cannot lead a claimPrincipal diagnosis not assigned to a clinical group | None | None |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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