R97.0
BillableElevated carcinoembryonic antigen [CEA]
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is R97.0 an HCC code?
No. R97.0 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
R97.0 is the ICD-10-CM diagnosis code for elevated carcinoembryonic antigen [cea]. A blood test shows elevated levels of carcinoembryonic antigen (CEA), a protein that can be associated with cancer or other conditions. R97.0 sits in the ICD-10-CM chapter for symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (r00-r99), within the section covering abnormal tumor markers (r97).
R97.0 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
CEA elevation alone does not confirm cancer; document the clinical context and any cancer diagnosis separately.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for R97.0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.