ICD-10 R97
Non-Billable HeaderAbnormal tumor markers
About ICD-10-CM R97
ICD-10-CM code R97 represents Abnormal tumor markers. This is a non-billable header code in the Symptoms, Signs, and Abnormal Findings chapter (block R97). The 2026 edition of ICD-10-CM R97 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under R97. Per CMS ICD-10-CM Tabular 2026.
- Elevated tumor associated antigens [TAA]
- Elevated tumor specific antigens [TSA]
Medicare LCD Coverage for R97
Local Coverage Determinations (LCDs) from CMS MACs that list R97 as a covered diagnosis.
This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R97.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but R97 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with R97
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 71020 Chest X-ray for respiratory symptoms Internal Medicine
Codes Adjacent To R97
Other codes in section R97 (Abnormal tumor markers).
ICD-10 R97, Billing FAQ
Is ICD-10 code R97 billable? +
No, R97 is a non-billable header code. Use a more specific child code from block R97 when submitting claims.
What other names or terms map to R97? +
ICD-10 R97 includes: Elevated tumor associated antigens [TAA]; Elevated tumor specific antigens [TSA].
What CPT codes are commonly billed with R97? +
Procedures frequently paired with R97 include: 71020.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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