ICD-10 · PDGM grouping
R97-R97 — Abnormal tumor markers
Every ICD-10-CM code in this range and the PDGM clinical group CMS assigns to it, read from the CMS grouper crosswalk v07.2.26.
Codes in range
5
No clinical group
5
A period cannot be grouped from these.
Barred as primary
0
CMS rejects these in the primary position.
Where these codes group
None of the 5 codes in R97-R97 is assigned a PDGM clinical group. A 30-day period cannot be grouped from any of them, so none can hold the primary position on a home health claim.
Code families in R97-R97
One page per three-character family: every code in it, whether it can lead a claim, its clinical group and comorbidity subgroup.
Every code in R97-R97
Descriptions are CMS’s own, abbreviated as CMS abbreviates them.
| Code | Description | Clinical group | Primary position |
|---|---|---|---|
| R970 | Elevated carcinoembryonic antigen [CEA] | None | Cannot lead a claim |
| R971 | Elevated cancer antigen 125 [CA 125] | None | Cannot lead a claim |
| R9720 | Elevated prostate specific antigen [PSA] | None | Cannot lead a claim |
| R9721 | Rising PSA fol treatment for malignant neoplasm of prostate | None | Cannot lead a claim |
| R978 | Other abnormal tumor markers | None | Cannot lead a claim |
Source: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01. 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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