US · guidance
CMS Pub. 100-04, ch. 32, § 150.5.1
ICD Codes for Type II Diabetes Mellitus Complication
E11.9 Type 2 diabetes mellitus without complications
E13.9 Other specified diabetes mellitus without complications
E11.65 Type 2 diabetes mellitus with hyperglycemia
E13.10 Other specified diabetes mellitus with ketoacidosis without coma
E11.69 Type 2 diabetes mellitus with other specified complication
Note: E11.69 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this policy.
E11.00 Type 2 diabetes mellitus with hyperosmolarity without nonketotic
hyperglycemic-hyperosmolar coma (NKHHC)
E11.01 Type 2 diabetes mellitus with hyperosmolarity with coma
E13.00 Other specified diabetes mellitus with hyperosmolarity without nonketotic
hyperglycemic-hyperosmolar coma (NKHHC)
E13.01 Other specified diabetes mellitus with hyperosmolarity with coma
Note: E11.00 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this policy.
E11.641 Type 2 diabetes mellitus with hypoglycemia with coma
E13.11 Other specified diabetes mellitus with ketoacidosis with coma
E13.641 Other specified diabetes mellitus with hypoglycemia with coma
Note: E11.01 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
E11.21 Type 2 diabetes mellitus with diabetic nephropathy
E11.22 Type 2 diabetes mellitus with diabetic chronic kidney disease
E11.29 Type 2 diabetes mellitus with other diabetic kidney complication
E13.21 Other specified diabetes mellitus with diabetic nephropathy
E13.22 Other specified diabetes mellitus with diabetic chronic kidney disease
E13.29 Other specified diabetes mellitus with other diabetic kidney complication
Note: E11.21 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
E11.3211 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with
macular edema, right eye
E11.3212 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with
macular edema, left eye
E11.3213 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy with
macular edema, bilateral
E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, right eye
E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, left eye
E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, bilateral
E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, right eye
E11.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, left eye
E11.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, bilateral
E11.3291 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
without macular edema, right eye
E11.3292 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
without macular edema, left eye
E11.3293 Type 2 diabetes mellitus with mild nonproliferative diabetic retinopathy
without macular edema, bilateral
E11.3311 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
with macular edema, right eye
E11.3312 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
with macular edema, left eye
E11.3313 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
with macular edema, bilateral
E11.3391 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
without macular edema, right eye
E11.3392 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
without macular edema, left eye
E11.3393 Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy
without macular edema, bilateral
E11.3411 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
with macular edema, right eye
E11.3412 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
with macular edema, left eye
E11.3413 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
with macular edema, bilateral
E11.3491 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
without macular edema, right eye
E11.3492 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
without macular edema, left eye
E11.3493 Type 2 diabetes mellitus with severe nonproliferative diabetic retinopathy
without macular edema, bilateral
E11.3511 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular
edema, right eye
E11.3512 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular
edema, left eye
E11.3513 Type 2 diabetes mellitus with proliferative diabetic retinopathy with macular
edema, bilateral
E11.3521 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment involving the macula, right eye
E11.3522 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment involving the macula, left eye
E11.3523 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment involving the macula, bilateral
E11.3531 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment not involving the macula, right eye
E11.3532 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment not involving the macula, left eye
E11.3533 Type 2 diabetes mellitus with proliferative diabetic retinopathy with traction
retinal detachment not involving the macula, bilateral
E11.3591 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, right eye
E11.3592 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, left eye
E11.3593 Type 2 diabetes mellitus with proliferative diabetic retinopathy without
macular edema, bilateral
E11.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, right eye
E11.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, left eye
E11.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, bilateral
E13.311 Other specified diabetes mellitus with unspecified diabetic retinopathy with
macular edema
E13.319 Other specified diabetes mellitus with unspecified diabetic retinopathy
without macular edema
E13.3211 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy with macular edema, right eye
E13.3212 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy with macular edema, left eye
E13.3213 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy with macular edema, bilateral
E13.3291 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy without macular edema, right eye
E13.3292 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy without macular edema, left eye
E13.3293 Other specified diabetes mellitus with mild nonproliferative diabetic
retinopathy without macular edema, bilateral
E13.3311 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy with macular edema, right eye
E13.3312 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy with macular edema, left eye
E13.3313 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy with macular edema, bilateral
E13.3391 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy without macular edema, right eye
E13.3392 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy without macular edema, left eye
E13.3393 Other specified diabetes mellitus with moderate nonproliferative diabetic
retinopathy without macular edema, bilateral
E13.3411 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy with macular edema, right eye
E13.3412 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy with macular edema, left eye
E13.3413 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy with macular edema, bilateral
E13.3491 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy without macular edema, right eye
E13.3492 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy without macular edema, left eye
E13.3493 Other specified diabetes mellitus with severe nonproliferative diabetic
retinopathy without macular edema, bilateral
E13.3511 Other specified diabetes mellitus with proliferative diabetic retinopathy with
macular edema, right eye
E13.3512 Other specified diabetes mellitus with proliferative diabetic retinopathy with
macular edema, left eye
E13.3513 Other specified diabetes mellitus with proliferative diabetic retinopathy with
macular edema, bilateral
E13.3521 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment involving the macula, right eye
E13.3522 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment involving the macula, left eye
E13.3523 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment involving the macula, bilateral
E13.3531 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment not involving the macula, right eye
E13.3532 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment not involving the macula, left eye
E13.3533 Other specified diabetes mellitus with proliferative diabetic retinopathy with
traction retinal detachment not involving the macula, bilateral
E13.3541 Other specified diabetes mellitus with proliferative diabetic retinopathy with
combined traction retinal detachment and rhegmatogenous retinal
detachment, right eye
E13.3542 Other specified diabetes mellitus with proliferative diabetic retinopathy with
combined traction retinal detachment and rhegmatogenous retinal
detachment, left eye
E13.3543 Other specified diabetes mellitus with proliferative diabetic retinopathy with
combined traction retinal detachment and rhegmatogenous retinal
detachment, bilateral
E13.3551 Other specified diabetes mellitus with stable proliferative diabetic
retinopathy, right eye
E13.3552 Other specified diabetes mellitus with stable proliferative diabetic
retinopathy, left eye
E13.3553 Other specified diabetes mellitus with stable proliferative diabetic
retinopathy, bilateral
E13.3591 Other specified diabetes mellitus with proliferative diabetic retinopathy
without macular edema, right eye
E13.3592 Other specified diabetes mellitus with proliferative diabetic retinopathy
without macular edema, left eye
E13.3593 Other specified diabetes mellitus with proliferative diabetic retinopathy
without macular edema, bilateral
E13.36 Other specified diabetes mellitus with diabetic cataract
E13.39 Other specified diabetes mellitus with other diabetic ophthalmic complication
E11.311 Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular
edema OR
E11.319 Type 2 diabetes mellitus with unspecified diabetic retinopathy without
macular edema OR
E11.36 Type 2 diabetes mellitus with diabetic cataract OR
E11.39 Type 2 diabetes mellitus with other diabetic ophthalmic complication AND
Note: E11.39 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy
E13.37X1 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, right eye
E13.37X2 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, left eye
E13.37X3 Type 2 diabetes mellitus with diabetic macular edema, resolved following
treatment, bilateral
E11.40 Type 2 diabetes mellitus with diabetic neuropathy, unspecified
E11.41 Type 2 diabetes mellitus with diabetic mononeuropathy
E11.42 Type 2 diabetes mellitus with diabetic polyneuropathy
E11.43 Type 2 diabetes mellitus with diabetic autonomic (poly)neuropathy
E11.44 Type 2 diabetes mellitus with diabetic amyotrophy
E11.49 Type 2 diabetes mellitus with other diabetic neurological complication
E11.610 Type 2 diabetes mellitus with diabetic neuropathic arthropathy
E13.40 Other specified diabetes mellitus with diabetic neuropathy, unspecified
E13.41 Other specified diabetes mellitus with diabetic mononeuropathy
E13.42 Other specified diabetes mellitus with diabetic polyneuropathy
E13.43 Other specified diabetes mellitus with diabetic autonomic (poly)neuropathy
E13.44 Other specified diabetes mellitus with diabetic amyotrophy
E13.49 Other specified diabetes mellitus with other diabetic neurological
complication
E13.610 Other specified diabetes mellitus with diabetic neuropathic arthropathy
Note: E11.40 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
E11.51 Type 2 diabetes mellitus with diabetic peripheral angiopathy without
gangrene
E11.52 Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.59 Type 2 diabetes mellitus with other circulatory complications
E13.51 Other specified diabetes mellitus with diabetic peripheral angiopathy without
gangrene
E13.52 Other specified diabetes mellitus with diabetic peripheral angiopathy with
gangrene
E13.59 Other specified diabetes mellitus with other circulatory complications
Note: E11.51 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
E11.618 Type 2 diabetes mellitus with other diabetic arthropathy
E11.620 Type 2 diabetes mellitus with diabetic dermatitis
E11.621 Type 2 diabetes mellitus with foot ulcer
E11.622 Type 2 diabetes mellitus with other skin ulcer
E11.628 Type 2 diabetes mellitus with other skin complications
E11.630 Type 2 diabetes mellitus with periodontal disease
E11.638 Type 2 diabetes mellitus with other oral complications
E11.649 Type 2 diabetes mellitus with hypoglycemia without coma
E13.618 Other specified diabetes mellitus with other diabetic arthropathy
E13.620 Other specified diabetes mellitus with diabetic dermatitis
E13.621 Other specified diabetes mellitus with foot ulcer
E13.622 Other specified diabetes mellitus with other skin ulcer
E13.628 Other specified diabetes mellitus with other skin complications
E13.630 Other specified diabetes mellitus with periodontal disease
E13.638 Other specified diabetes mellitus with other oral complications
E13.649 Other specified diabetes mellitus with hypoglycemia without coma
E13.65 Other specified diabetes mellitus with hyperglycemia
E13.69 Other specified diabetes mellitus with other specified complication
Note: E11.69 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
E13.8 Other specified diabetes mellitus with unspecified complications
E11.8 Type 2 diabetes mellitus with unspecified complications
Note: E11.8 with E11.65 are a cluster BUT since each code on its own
justifies the service, the combination is not required together for this
policy.
History
(Rev. 11021; Issued: 10-01-21; Effective: 10-29-21; Implementation: 10-29-21)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
c8dce2a2e00dc576e8727aa30e24a68bc6557975711e283e1c52afbc622922c1
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.