2026 ICD-10-CM Diagnosis Code R97.21Rising PSA following treatment for malignant neoplasm of prostate

ICD-10-CM Codes›R00–R99›R97›R97

ICD-10-CM R97.21
CMSSource: CMS FY 2026 ICD-10-CM dataset · Effective Oct 1, 2025 – Sep 30, 2026

R97.21 is a billable ICD-10-CM diagnosis code for rising PSA following treatment for malignant neoplasm of prostate. It is valid on HIPAA claims for fiscal year 2026 (October 1, 2025 through September 30, 2026) and groups to MS-DRG 947 through 948. The code is restricted by the Medicare Code Editor to adult patients (age 15 through 124) and flagged as a questionable admission, since it rarely justifies inpatient admission on its own. As a symptom code, it should not be used as a principal diagnosis once a related definitive diagnosis has been established. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Abnormal findings without diagnosis.

Code Identity

ICD-10-CM Code
R97.21
Billable Status
Yes — Valid for Submission
Code Describes
Rising PSA following treatment for malignant neoplasm of prostate
Short Description
Rising PSA fol treatment for malignant neoplasm of prostate
Parent Code
R97.2
Elevated prostate specific antigen [PSA]

Code Classification

ChapterR00–R99Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
SectionR97Abnormal tumor markers
CategoryR97Abnormal tumor markers
This CodeR97.21Rising PSA following treatment for malignant neoplasm of prostate

Code EditsBilling

Medicare Code Editor checks that affect claim validity for R97.21.

Adult diagnoses
The Medicare Code Editor detects inconsistencies in adult cases by checking a patient's age and any diagnosis on the patient's record. The adult code edits apply to patients age range is 15–124 years inclusive (e.g., senile delirium, mature cataract).
Questionable admission codes
Some diagnoses are not usually sufficient justification for admission to an acute care hospital. For example, if a patient is given code R030 for elevated blood pressure reading, without diagnosis of hypertension, then the patient would have a questionable admission, since elevated blood pressure reading is not normally sufficient justification for admission to a hospital. The following list contains diagnosis codes identified as questionable admission when used.

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

External Cause of Injuries IndexGuidance

References for this code in the External Cause of Injuries Index.

    • Rising, PSA following treatment for malignant neoplasm of prostate

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR SYM017
Abnormal findings without diagnosis
Default principal diagnosis: inpatient Yes · outpatient Yes

Patient EducationClinical

Prostate-Specific Antigen (PSA) Test

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Convert R97.21 to ICD-9-CMHistory

The closest ICD-9-CM equivalents under the General Equivalence Mappings.

ICD-9-CM
790.93 Elvtd prstate spcf antgn
Approximate The match is approximate rather than exact.

Code History & ChangesHistory

Replacement R97.21 replaces the following previously assigned code(s):

  • R97.2 - Elevated prostate specific antigen [PSA]
FY 2018AddedAdded to the ICD-10-CM code setEffective October 1, 2017.
FY 2019–2025No changes
FY 2026CurrentCurrent code set, no changesEffective October 1, 2025 through September 30, 2026.

Questions About R97.21Overview

Is R97.21 (Elevated prostate specific antigen [PSA]) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report rising PSA following treatment for malignant neoplasm of prostate on HIPAA-covered claims from October 1, 2025 through September 30, 2026.

What MS-DRG does R97.21 group to?

When rising PSA following treatment for malignant neoplasm of prostate is the principal diagnosis on an inpatient stay, it groups to MS-DRG 947, 948, with relative weights from 0.8005 to 1.2694 depending on complications. Higher weights mean higher Medicare reimbursement.

Can R97.21 be a principal diagnosis?

Use it with care. This is a symptom code, so once a definitive diagnosis explaining the rising PSA following treatment for malignant neoplasm of prostate is established, that condition takes the principal position instead.

Who can R97.21 be reported for?

The Medicare Code Editor checks rising PSA following treatment for malignant neoplasm of prostate against patient demographics: this code is intended for adult patients (age 15 through 124). Claims outside these limits are flagged as inconsistent.

Does R97.21 justify an inpatient admission?

Not on its own. The Medicare Code Editor lists this code as a questionable admission because rising PSA following treatment for malignant neoplasm of prostate is not usually sufficient justification for admission to an acute care hospital.

Footnotes

[1] Not chronic - A diagnosis code that does not fit the criteria for chronic condition (duration, ongoing medical treatment, and limitations) is considered not chronic. Some codes designated as not chronic are acute conditions. Other diagnosis codes that indicate a possible chronic condition, but for which the duration of the illness is not specified in the code description (i.e., we do not know the condition has lasted 12 months or longer) also are considered not chronic.