ICD-10 E11.331
Non-Billable HeaderType 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema
About ICD-10-CM E11.331
ICD-10-CM code E11.331 represents Type 2 diabetes mellitus with moderate nonproliferative diabetic retinopathy with macular edema. This is a non-billable header code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.331 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.
Medicare LCD Coverage for E11.331
Local Coverage Determinations (LCDs) from CMS MACs that list E11.331 as a covered diagnosis.
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 E11.331.
Our payer policy database covers Aetna, Cigna, Anthem, BCBS, Humana, and Medicare Advantage plans, but E11.331 doesn't currently appear in any indexed policy. The code may still be covered under standard plan benefits.
CPT Codes Commonly Billed with E11.331
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 67028 Intravitreal injection — wet AMD, macular degeneration, diabetic macular edema, diabetic retinopathy, retinal vein occlusion Ophthalmology
- 67028 Intravitreal injection — wet/dry AMD all stages both eyes, diabetic macular edema, diabetic retinopathy, retinal vein occlusion, macular edema Ophthalmology
Codes Adjacent To E11.331
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.331, Billing FAQ
Is ICD-10 code E11.331 billable? +
No, E11.331 is a non-billable header code. Use a more specific child code from block E11 when submitting claims.
What CPT codes are commonly billed with E11.331? +
Procedures frequently paired with E11.331 include: 67028, 67028.
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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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