ICD-10 R97.20
Billable / SpecificElevated prostate specific antigen [PSA]
About ICD-10-CM R97.20
ICD-10-CM code R97.20 represents Elevated prostate specific antigen [PSA]. This is a billable/specific code in the Symptoms, Signs, and Abnormal Findings chapter (block R97). The 2026 edition of ICD-10-CM R97.20 became effective on October 1, 2025.
Medicare LCD Coverage for R97.20
Local Coverage Determinations (LCDs) from CMS MACs that list R97.20 as a covered diagnosis.
Showing top 10 of 267 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing R97.20.
4 Aetna
5 Medicare
CPT Codes Commonly Billed with R97.20
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 55700 Prostate biopsy — elevated PSA, BPH, prostate cancer Urology
- 55700 Prostate biopsy — elevated PSA, prostate disorder, prostate cancer, family hx prostate cancer, urinary retention, prostate screening Urology
- 0359U CMS LCD: Billing and Coding: Prostate Cancer Detection with IsoPSA� CMS LCD
- 81539 CMS LCD: Billing and Coding: 4Kscore Test Algorithm CMS LCD
Convert R97.20 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| R97.20 | 79093 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To R97.20
Other codes in section R97 (Abnormal tumor markers).
ICD-10 R97.20, Billing FAQ
Is ICD-10 code R97.20 billable? +
Yes, R97.20 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What CPT codes are commonly billed with R97.20? +
Procedures frequently paired with R97.20 include: 55700, 55700, 0359U, 81539.
What ICD-9 codes does R97.20 map to? +
Per CMS GEMs, R97.20 maps to ICD-9 codes: 79093. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on July 16, 2026.
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