E11.319: Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema

E11.319, type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, is listed as a covered diagnosis in 14 Medicare billing and coding articles that apply to 144 HCPCS Level II codes, including G0127 (Trimming of dystrophic nails, any number), J3490 (Unclassified drugs), J7999 (Compounded drug, not otherwise classified). 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 7 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 E11.319 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
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
J0153Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)Special coverage instructions apply—2
J1250Injection, dobutamine hydrochloride, per 250 mgSpecial coverage instructions apply—2
J1245Injection, dipyridamole, per 10 mgSpecial coverage instructions apply—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
J3590Unclassified biologicsCarrier 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

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

Medicare policy articles listing E11.319

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 E11.319 (Type 2 diabetes mellitus with unspecified diabetic…)?

Medicare covers items and services, not diagnoses. 14 Medicare billing and coding articles list E11.319 as a covered diagnosis for 144 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 E11.319?

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); J7999 (Compounded drug, not otherwise classified, 2 articles); E2103 (Non-adjunctive, non-implanted continuous glucose monitor…, 2 articles); A4239 (Supply allowance for non-adjunctive, non-implanted…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with E11.319?

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 E11.319?

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 E11.319?

E11.319 is the ICD-10-CM code for type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema, 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