E13.3519: Other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye

E13.3519, other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye, is listed as a covered diagnosis in 8 Medicare billing and coding articles that apply to 115 HCPCS Level II codes, including G0127 (Trimming of dystrophic nails, any number), E2103 (Non-adjunctive, non-implanted continuous glucose monitor…), A4239 (Supply allowance for non-adjunctive, non-implanted…). 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 5 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 E13.3519 as a covered diagnosis

CodeDescriptionMedicare coverageDMEPOS fee 2026 (state range)Articles listing it
G0127Trimming of dystrophic nails, any numberSpecial coverage instructions apply—3
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
J3490Unclassified drugsSpecial coverage instructions apply—2
G0299Direct skilled nursing services of a registered nurse (rn) in the home health or hospice setting, each 15 minutesCarrier judgment—1
G0300Direct skilled nursing services of a licensed practical nurse (lpn) in the home health or hospice setting, each 15 minutesCarrier judgment—1
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

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

Medicare policy articles listing E13.3519

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 E13 diagnoses (Other specified diabetes mellitus)

Frequently asked questions

Does Medicare cover E13.3519 (Other specified diabetes mellitus with proliferative…)?

Medicare covers items and services, not diagnoses. 8 Medicare billing and coding articles list E13.3519 as a covered diagnosis for 115 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 E13.3519?

The Level II codes from the policies most specific to this diagnosis are G0127 (Trimming of dystrophic nails, any number, 3 articles); E2103 (Non-adjunctive, non-implanted continuous glucose monitor…, 2 articles); A4239 (Supply allowance for non-adjunctive, non-implanted…, 2 articles); A4238 (Supply allowance for adjunctive, non-implanted continuous…, 2 articles); E2102 (Adjunctive, non-implanted continuous glucose monitor or…, 2 articles). Code choice depends on the item supplied; check each code's descriptor.

What does Medicare pay for equipment billed with E13.3519?

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 E13.3519?

A56674 (Billing and Coding: Home Health Plans of Care: Monitoring Glucose Control in the Medicare Home Health Population with Type II Diabetes Mellitus); A52501 (Therapeutic Shoes for Persons with Diabetes - Policy Article); A52507 (External Infusion Pumps - Policy Article), and 5 more articles.

What is ICD-10-CM code E13.3519?

E13.3519 is the ICD-10-CM code for other specified diabetes mellitus with proliferative diabetic retinopathy with macular edema, unspecified eye, in category E13 (Other specified 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