E11.11: Type 2 diabetes mellitus with ketoacidosis with coma

E11.11, type 2 diabetes mellitus with ketoacidosis with coma, is listed as a covered diagnosis in 10 Medicare billing and coding articles that apply to 68 HCPCS Level II codes, including G0127 (Trimming of dystrophic nails, any number), L5000 (Partial foot, shoe insert with longitudinal arch, toe filler), A5501 (For diabetics only, fitting (including follow-up), custom…). 33 of these codes have a 2026 DMEPOS fee schedule amount; L5000 pays $618.56 to $999.36 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 E11.11 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0127Trimming of dystrophic nails, any numberSpecial coverage instructions apply—3
L5000Partial foot, shoe insert with longitudinal arch, toe fillerSpecial coverage instructions apply$618.56–$999.361
A5501For diabetics only, fitting (including follow-up), custom preparation and supply of shoe molded from cast(s) of patient's foot (custom molded shoe), per shoeSpecial coverage instructions apply$271.801
L3224Orthopedic footwear, woman's shoe, oxford, used as an integral part of a brace (orthosis)Special coverage instructions apply$67.57–$152.321
L3225Orthopedic footwear, man's shoe, oxford, used as an integral part of a brace (orthosis)Special coverage instructions apply$77.73–$140.821
A5500For diabetics only, fitting (including follow-up), custom preparation and supply of off-the-shelf depth-inlay shoe manufactured to accommodate multi-density insert(s), per shoeSpecial coverage instructions apply$90.631
A5514For diabetics only, multiple density insert, made by direct carving with cam technology from a rectified cad model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, eachSpecial coverage instructions apply$55.161
A5513For diabetics only, multiple density insert, custom molded from model of patient's foot, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, eachSpecial coverage instructions apply$55.161
A5503For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with roller or rigid rocker bottom, per shoeSpecial coverage instructions apply$45.791
A5504For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with wedge(s), per shoeSpecial coverage instructions apply$45.791
A5507For diabetics only, not otherwise specified modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoeSpecial coverage instructions apply$45.791
A5505For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with metatarsal bar, per shoeSpecial coverage instructions apply$45.791
A5506For diabetics only, modification (including fitting) of off-the-shelf depth-inlay shoe or custom-molded shoe with off-set heel(s), per shoeSpecial coverage instructions apply$45.791
A5512For diabetics only, multiple density insert, direct formed, molded to foot after external heat source of 230 degrees fahrenheit or higher, total contact with patient's foot, including arch, base layer minimum of 1/4 inch material of shore a 35 durometer or 3/16 inch material of shore a 40 durometer (or higher), prefabricated, eachSpecial coverage instructions apply$36.961
L5999Lower extremity prosthesis, not otherwise specifiedCarrier judgment—1
A5508For diabetics only, deluxe feature of off-the-shelf depth-inlay shoe or custom-molded shoe, per shoeSpecial coverage instructions apply—1
A5510For diabetics only, direct formed, compression molded to patient's foot without external heat source, multiple-density insert(s) prefabricated, per shoeSpecial coverage instructions apply—1
L3230Orthopedic footwear, custom shoe, depth inlay, eachSpecial coverage instructions apply—1
L3250Orthopedic footwear, custom molded shoe, removable inner mold, prosthetic shoe, eachSpecial coverage instructions apply—1
L3251Foot, shoe molded to patient model, silicone shoe, eachSpecial coverage instructions apply—1
L3252Foot, shoe molded to patient model, plastazote (or similar), custom fabricated, eachSpecial coverage instructions apply—1
L3253Foot, molded shoe plastazote (or similar) custom fitted, eachSpecial coverage instructions apply—1
E2100Blood glucose monitor with integrated voice synthesizerSpecial coverage instructions apply$650.29–$1,084.76 (NU)1
E2103Non-adjunctive, non-implanted continuous glucose monitor or receiverCarrier judgment$256.09–$334.44 (NU)1
E2101Blood glucose monitor with integrated lancing/blood sampleSpecial coverage instructions apply$268.71–$322.42 (NU)1

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

Medicare policy articles listing E11.11

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 E11 diagnoses (Type 2 diabetes mellitus)

Frequently asked questions

Does Medicare cover E11.11 (Type 2 diabetes mellitus with ketoacidosis with coma)?

Medicare covers items and services, not diagnoses. 10 Medicare billing and coding articles list E11.11 as a covered diagnosis for 68 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 E11.11?

The Level II codes from the policies most specific to this diagnosis are G0127 (Trimming of dystrophic nails, any number, 3 articles); L5000 (Partial foot, shoe insert with longitudinal arch, toe filler, 1 article); A5501 (For diabetics only, fitting (including follow-up), custom…, 1 article); L3224 (Orthopedic footwear, woman's shoe, oxford, used as an…, 1 article); L3225 (Orthopedic footwear, man's shoe, oxford, used as an…, 1 article). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with E11.11?

Under the 2026 DMEPOS fee schedule (non-rural state fees): L5000 $618.56 to $999.36; A5501 $271.80; L3224 $67.57 to $152.32; L3225 $77.73 to $140.82. Medicare pays 80% of the allowed amount after the Part B deductible.

Which Medicare policy articles list E11.11?

A52501 (Therapeutic Shoes for Persons with Diabetes - Policy Article); A52464 (Glucose Monitor - Policy Article); A52996 (Billing and Coding: Routine Foot Care), and 7 more articles.

What is ICD-10-CM code E11.11?

E11.11 is the ICD-10-CM code for type 2 diabetes mellitus with ketoacidosis with coma, in category E11 (Type 2 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