E10.3511: Type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye

E10.3511, type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye, is listed as a covered diagnosis in 14 Medicare billing and coding articles that apply to 140 HCPCS Level II codes, including G0127 (Trimming of dystrophic nails, any number), J3490 (Unclassified drugs), J3590 (Unclassified biologics). 54 of these codes have a 2026 DMEPOS fee schedule amount; E2103 pays $256.09 to $334.44 (NU) depending on the state. The articles come from 6 Medicare contractors. A listed diagnosis supports medical necessity only; coverage still depends on the LCD's criteria and on documentation in the medical record.

HCPCS Level II codes with E10.3511 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0127Trimming of dystrophic nails, any numberSpecial coverage instructions apply—5
J3490Unclassified drugsSpecial coverage instructions apply—3
J3590Unclassified biologicsCarrier judgment—2
C9257Injection, bevacizumab, 0.25 mgSpecial coverage instructions apply—2
J7999Compounded drug, not otherwise classifiedSpecial coverage instructions apply—2
E2103Non-adjunctive, non-implanted continuous glucose monitor or receiverCarrier judgment$256.09–$334.44 (NU)2
A4239Supply allowance for non-adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of serviceCarrier judgment$273.282
A4238Supply allowance for adjunctive, non-implanted continuous glucose monitor (CGM), includes all supplies and accessories, 1 month supply = 1 unit of serviceCarrier judgment$280.71 (KF)2
E2102Adjunctive, non-implanted continuous glucose monitor or receiverCarrier judgment$189.08–$239.22 (NU)2
E1399Durable medical equipment, miscellaneousCarrier judgment—2
A9999Miscellaneous dme supply or accessory, not otherwise specifiedCarrier judgment—2
J2777Injection, faricimab-svoa, 0.1 mgCarrier judgment—1
J0178Injection, aflibercept, 1 mgCarrier judgment—1
J0177Injection, aflibercept hd, 1 mgCarrier judgment—1
Q5128Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mgCarrier judgment—1
J2778Injection, ranibizumab, 0.1 mgCarrier judgment—1
Q5124Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mgCarrier judgment—1
J0179Injection, brolucizumab-dbll, 1 mgCarrier judgment—1
J2779Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mgCarrier judgment—1
C9399Unclassified drugs or biologicalsSpecial coverage instructions apply—1
Q5147Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mgCarrier judgment—1
Q5149Injection, aflibercept-abzv (enzeevu), biosimilar, 1 mgCarrier judgment—1
Q5150Injection, aflibercept-mrbb (ahzantive), biosimilar, 1 mgCarrier judgment—1
Q5153Injection, aflibercept-yszy (opuviz), biosimilar, 1 mgCarrier judgment—1
Q5155Injection, aflibercept-jbvf (yesafili), biosimilar, 1 mgCarrier judgment—1

115 more codes are listed. See every code with payment by region in Caduvo.

Medicare policy articles listing E10.3511

A diagnosis listed as covered in a billing and coding article supports medical necessity for the article's codes; it does not guarantee payment. Coverage depends on the LCD's criteria, the contractor's jurisdiction and documentation in the medical record.

Other E10 diagnoses (Type 1 diabetes mellitus)

Frequently asked questions

Does Medicare cover E10.3511 (Type 1 diabetes mellitus with proliferative diabetic…)?

Medicare covers items and services, not diagnoses. 14 Medicare billing and coding articles list E10.3511 as a covered diagnosis for 140 HCPCS Level II codes: the diagnosis can support medical necessity for those codes, but payment still depends on the LCD's coverage criteria and the medical record.

Which HCPCS codes can be billed with ICD-10 E10.3511?

The Level II codes from the policies most specific to this diagnosis are G0127 (Trimming of dystrophic nails, any number, 5 articles); J3490 (Unclassified drugs, 3 articles); J3590 (Unclassified biologics, 2 articles); C9257 (Injection, bevacizumab, 0.25 mg, 2 articles); J7999 (Compounded drug, not otherwise classified, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with E10.3511?

Under the 2026 DMEPOS fee schedule (non-rural state fees): E2103 $256.09 to $334.44 (NU); A4239 $273.28; A4238 $280.71 (KF); E2102 $189.08 to $239.22 (NU). Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list E10.3511?

A52451 (Billing and Coding: Ranibizumab, Aflibercept and biosimilars); A56674 (Billing and Coding: Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus); A56686 (Billing and Coding: HbA1c), and 11 more articles.

What is ICD-10-CM code E10.3511?

E10.3511 is the ICD-10-CM code for type 1 diabetes mellitus with proliferative diabetic retinopathy with macular edema, right eye, in category E10 (Type 1 diabetes mellitus), chapter 4: Endocrine, nutritional and metabolic diseases.

Next steps

Sources: CMS Medicare Coverage Database billing and coding articles (covered ICD-10 code lists and HCPCS links); ICD-10-CM FY2026; CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule 2026 (non-rural state fees). Not billing or legal advice.

Chapter 4: Endocrine, nutritional and metabolic diseases · All diagnoses · HCPCS lookup