E11.3599 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye

Code definition & billing validity

Coding context for E11.3599

Type 2 diabetes mellitus codes fall under Chapter IV — Endocrine, nutritional and metabolic diseases (E00–E89). These are among the most frequently billed ICD-10-CM codes in outpatient Medicare and are subject to active CMS quality measure and LCD monitoring.

Source: CDC ICD-10-CM Tabular List · CMS National Coverage Analysis

Coverage check · verified

Which Medicare LCDs cover E11.3599, by MAC?

The LCDs whose CMS Billing & Coding article lists E11.3599as covered or non-covered — each jurisdiction, effective-dated, linked to the government document. No guesses; if a policy isn’t on file we say so.

MAC coverage considerations

Local Coverage Determinations (LCDs) from Medicare Administrative Contractors may impose medical necessity requirements for services billed with E11.3599. Coverage criteria vary by MAC jurisdiction. Every contractor publishes its LCDs to the CMS Medicare Coverage Database, and CLV Intelligence tracks that database daily for LCD updates affecting this code and related codes.

MAC jurisdiction coverage

All seven Medicare Administrative Contractors (MACs) are monitored daily for LCD revisions, billing guidance, and coverage policy updates affecting ICD-10-CM E11.3599.

Related ICD-10-CM codes & category

Frequently asked

What are the active CMS reimbursement alerts for ICD-10-CM code E11.3599?

According to CLV Intelligence data, 1 active CMS and MAC reimbursement policy changes are matched to ICD-10-CM code E11.3599 (Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye) by CLV analysis of each policy. Policies are sourced from CMS transmittals, Medicare Administrative Contractor (MAC) Local Coverage Determinations (LCDs), and Federal Register notices; the linked source document is authoritative. Data is updated daily.

Which MAC contractors publish LCD or billing guidance for E11.3599?

According to CLV Intelligence data, Local Coverage Determinations (LCDs) and billing guidance relevant to ICD-10-CM code E11.3599 (Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye) may be issued by any of the seven Medicare Administrative Contractors (MACs): Noridian Healthcare Solutions (Jurisdictions E and F), CGS Administrators (Jurisdiction 15), Palmetto GBA (Jurisdictions J and M), NGS (Jurisdictions 6 and K), WPS Government Health Administrators (Jurisdictions 5 and 8), First Coast Service Options (Jurisdiction N), and Novitas Solutions (Jurisdictions H and L). CLV Intelligence monitors all MAC jurisdictions daily and surfaces alerts by jurisdiction so clinical coders can filter to their region.

Is ICD-10-CM code E11.3599 billable under Medicare in 2025–2026?

ICD-10-CM code E11.3599 — Type 2 diabetes mellitus with proliferative diabetic retinopathy without macular edema, unspecified eye — is a valid billable diagnosis code under the ICD-10-CM FY2026 code set maintained by the Centers for Disease Control and Prevention (CDC) and adopted by CMS for Medicare and Medicaid billing. CLV Intelligence tracks CMS fee schedule updates, LCD revisions, and coverage policy changes that may affect reimbursement eligibility for this code. Coders should verify against the most recent MAC LCD and CMS NCCI edits before submission.

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