ICD-10-CM Code For Abnormal Tumor Markers: Group Overview

The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code group R97 includes codes for abnormal tumor marker levels detected on laboratory testing, covering elevated or otherwise abnormal biochemical markers associated with possible neoplastic processes. These ICD-10-CM diagnosis codes are used to document the presence of abnormal tumor marker results, capturing the diagnostic finding and clinical complexity related to further evaluation or monitoring. Accurate coding within the ICD-10-CM R97 group supports proper claim adjudication, complete clinical documentation, and appropriate reimbursement.

Customize your policy alerts

Sign up for ICD-10-CM Code For Abnormal Tumor Markers: Group Overview policy alerts

Get alerted when relevant policies change without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

ICD-10-CM R97: Abnormal Tumor Markers Overview

This group includes codes for abnormal tumor marker levels identified on laboratory testing, reflecting biochemical indicators rather than confirmed malignancy. It targets tests related to neoplastic markers across organ systems, such as prostate, ovarian, and gastrointestinal tumor markers. Accurate coding ensures the clinical reason for testing is documented and supports appropriate reimbursement for diagnostic services.

Explore openpayer tools

View all tools

ICD-10-CM Code For Abnormal Tumor Markers: Group Overview

Customize your policy alerts

Sign up for ICD-10-CM Code For Abnormal Tumor Markers: Group Overview policy alerts

Get alerted when relevant policies change without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

ICD-10-CM R97: Abnormal Tumor Markers Overview

When to Use

Use a code from this group when laboratory testing has documented abnormal tumor marker levels and the abnormality is the primary reason for visit or service. These codes are appropriate for reporting biochemical findings that prompt further diagnostic evaluation, surveillance, or clinical correlation rather than confirmed malignancy.

ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
R97.0	Elevated carcinoembryonic antigen [CEA]
R97.1	Elevated cancer antigen 125 [CA 125]
R97.20	Elevated prostate specific antigen [PSA]
R97.21	Rising PSA following treatment for malignant neoplasm of prostate
R97.8	Other abnormal tumor markers

DRG Codes

2 rows

DRG Code	Description
947	Signs and Symptoms with MCC
948	Signs and Symptoms without MCC

Typical Clinical Scenarios

An asymptomatic adult undergoing routine surveillance after prostate cancer treatment presents for blood work showing a rising prostate-specific antigen (PSA) level without other clinical or radiographic evidence of recurrence; this abnormal tumor marker result prompts further oncologic workup and is coded to reflect an elevated PSA finding. Typical codes: R97.21
A middle-aged woman evaluated in outpatient gastroenterology clinic for unexplained weight loss and abdominal pain has isolated elevation of carcinoembryonic antigen (CEA) on laboratory testing; the clinician documents the abnormal tumor marker as a laboratory finding pending correlation with imaging and endoscopy. Typical codes: R97.0
An emergency department patient with known metastatic breast cancer presents with acute worsening dyspnea and is found to have markedly elevated cancer antigen 15-3 (CA 15-3) compared with prior values, used as a marker of disease progression and recorded as an abnormal tumor marker concurrent with the acute decompensation. Typical codes: R97.1, R97.8}

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Explore openpayer tools

View all tools

When to Use

ICD-10-CM Codes

5 rows

ICD-10-CM Code	Description
R97.0	Elevated carcinoembryonic antigen [CEA]
R97.1	Elevated cancer antigen 125 [CA 125]
R97.20	Elevated prostate specific antigen [PSA]
R97.21	Rising PSA following treatment for malignant neoplasm of prostate
R97.8	Other abnormal tumor markers

DRG Codes

2 rows

DRG Code	Description
947	Signs and Symptoms with MCC
948	Signs and Symptoms without MCC

Typical Clinical Scenarios

An asymptomatic adult undergoing routine surveillance after prostate cancer treatment presents for blood work showing a rising prostate-specific antigen (PSA) level without other clinical or radiographic evidence of recurrence; this abnormal tumor marker result prompts further oncologic workup and is coded to reflect an elevated PSA finding. Typical codes: R97.21
A middle-aged woman evaluated in outpatient gastroenterology clinic for unexplained weight loss and abdominal pain has isolated elevation of carcinoembryonic antigen (CEA) on laboratory testing; the clinician documents the abnormal tumor marker as a laboratory finding pending correlation with imaging and endoscopy. Typical codes: R97.0
An emergency department patient with known metastatic breast cancer presents with acute worsening dyspnea and is found to have markedly elevated cancer antigen 15-3 (CA 15-3) compared with prior values, used as a marker of disease progression and recorded as an abnormal tumor marker concurrent with the acute decompensation. Typical codes: R97.1, R97.8}

Frequently Asked Questions

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

ICD-10-CM Code For Abnormal Tumor Markers: Group Overview

Sign up for ICD-10-CM Code For Abnormal Tumor Markers: Group Overview policy alerts

ICD-10-CM R97: Abnormal Tumor Markers Overview

ICD-10-CM Code For Abnormal Tumor Markers: Group Overview

Sign up for ICD-10-CM Code For Abnormal Tumor Markers: Group Overview policy alerts

ICD-10-CM R97: Abnormal Tumor Markers Overview

When to Use

ICD-10-CM Codes

DRG Codes

Typical Clinical Scenarios

When should I use codes from the ICD-10-CM R97 group?

Which specific tumor marker codes are included in the `R97` group?

How does accurate coding of `R97` codes affect billing and reimbursement?

Can I use `R97` codes to indicate a confirmed cancer diagnosis?

Which DRGs are related to the `R97` abnormal tumor markers group?

References

When to Use

ICD-10-CM Codes

DRG Codes

Typical Clinical Scenarios

When should I use codes from the ICD-10-CM R97 group?

Which specific tumor marker codes are included in the `R97` group?

How does accurate coding of `R97` codes affect billing and reimbursement?

Can I use `R97` codes to indicate a confirmed cancer diagnosis?

Which DRGs are related to the `R97` abnormal tumor markers group?

References