ICD-10-CM 2026 · Effective October 1, 2025

ICD-10 E11

Non-Billable Header

Type 2 diabetes mellitus

E11
Block
0
Synonyms
0
LCDs
4
Payer Policies
1
Linked CPTs

About ICD-10-CM E11

ICD-10-CM code E11 represents Type 2 diabetes mellitus. This is a non-billable header code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11 became effective on October 1, 2025. Non-billable codes cannot be used as a primary or secondary diagnosis on a claim, use a more specific child code instead.

Type 1 Excludes

Pure excludes, these codes can never be coded together with E11. The conditions are mutually exclusive (e.g., congenital vs acquired forms).

  • diabetes mellitus due to underlying condition (E08.-)
  • drug or chemical induced diabetes mellitus (E09.-)
  • gestational diabetes (O24.4-)
  • neonatal diabetes mellitus (P70.2)
  • postpancreatectomy diabetes mellitus (E13.-)
  • postprocedural diabetes mellitus (E13.-)
  • secondary diabetes mellitus NEC (E13.-)
  • type 1 diabetes mellitus (E10.-)

Includes

  • diabetes (mellitus) due to insulin secretory defect
  • diabetes NOS
  • insulin resistant diabetes (mellitus)

Use Additional Code

When coding E11, also report these additional codes when applicable.

  • code to identify control using:
  • injectable non-insulin antidiabetic drugs (Z79.85)
  • insulin (Z79.4)
  • oral antidiabetic drugs (Z79.84)
  • oral hypoglycemic drugs (Z79.84)

Medicare LCD Coverage for E11

Local Coverage Determinations (LCDs) from CMS MACs that list E11 as a covered diagnosis.

No Medicare LCDs reference E11 as covered

This doesn't mean the code isn't covered, it means no MAC has issued a Local Coverage Determination naming this specific code. Coverage may still apply under National Coverage Determinations or general medical-necessity rules.

Commercial Payer Coverage

Coverage policies from major commercial payers referencing E11.

4 policies

1 Aetna

Cardiac Rehabilitation: Outpatient - Medical Clinical Policy Bulletins | Aetna
Policy ID: CPB-0021

3 Cigna

Duplex Scan of Extracranial Arteries - (0542)
Policy ID: MM_0542
Headache, Occipital, and/or Trigeminal Neuralgia Treatment - (0063)
Policy ID: MM_0063
Peripheral Nerve Destruction for Pain Conditions - (0525) ---- future effective policy
Policy ID: MM_0525

CPT Codes Commonly Billed with E11

Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.

1 linkages
  • 80053 Comprehensive metabolic panel for diabetes management Internal Medicine

Codes Adjacent To E11

Other codes in section E08-E13 (Diabetes mellitus).

E08 Diabetes mellitus due to underlying condition (non-billable) E08.0 Diabetes mellitus due to underlying condition with hyperosmolarity (non-billable) E08.00 Diabetes mellitus due to underlying condition with hyperosmolarity without nonketotic hyperglycemic-hyperosmolar coma (NKHHC) E08.01 Diabetes mellitus due to underlying condition with hyperosmolarity with coma E08.1 Diabetes mellitus due to underlying condition with ketoacidosis (non-billable) E08.10 Diabetes mellitus due to underlying condition with ketoacidosis without coma E08.11 Diabetes mellitus due to underlying condition with ketoacidosis with coma E08.2 Diabetes mellitus due to underlying condition with kidney complications (non-billable) E08.21 Diabetes mellitus due to underlying condition with diabetic nephropathy E08.22 Diabetes mellitus due to underlying condition with diabetic chronic kidney disease E08.29 Diabetes mellitus due to underlying condition with other diabetic kidney complication E08.3 Diabetes mellitus due to underlying condition with ophthalmic complications (non-billable) E08.31 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy (non-billable) E08.311 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy with macular edema E08.319 Diabetes mellitus due to underlying condition with unspecified diabetic retinopathy without macular edema E08.32 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy (non-billable) E08.321 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy with macular edema (non-billable) E08.329 Diabetes mellitus due to underlying condition with mild nonproliferative diabetic retinopathy without macular edema (non-billable) E08.33 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy (non-billable) E08.331 Diabetes mellitus due to underlying condition with moderate nonproliferative diabetic retinopathy with macular edema (non-billable)

ICD-10 E11, Billing FAQ

Is ICD-10 code E11 billable? +

No, E11 is a non-billable header code. Use a more specific child code from block E11 when submitting claims.

What codes are Type 1 Excludes for E11? +

Type 1 Excludes (never code together with E11): diabetes mellitus due to underlying condition (E08.-); drug or chemical induced diabetes mellitus (E09.-); gestational diabetes (O24.4-)

What CPT codes are commonly billed with E11? +

Procedures frequently paired with E11 include: 80053.

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Reviewed by the PayerReady Medical Coding Team

Verified against the CMS 2026 code set on May 31, 2026.

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