ICD-10 E11.65
Billable / Specific HCC v28: 18Type 2 diabetes mellitus with hyperglycemia
About ICD-10-CM E11.65
ICD-10-CM code E11.65 represents Type 2 diabetes mellitus with hyperglycemia. This is a billable/specific code in the Endocrine, Nutritional, and Metabolic chapter (block E11). The 2026 edition of ICD-10-CM E11.65 became effective on October 1, 2025.
Coding Tips for E11.65
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
E11.65 is a CMS-HCC v28 risk-adjustment code (category 18). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Medicare LCD Coverage for E11.65
Local Coverage Determinations (LCDs) from CMS MACs that list E11.65 as a covered diagnosis.
Showing top 10 of 271 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing E11.65.
5 Medicare
CPT Codes Commonly Billed with E11.65
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 99215 Complex chronic disease management Internal Medicine
- 99205 New patient office visit — complex/high-risk: uncontrolled diabetes, heart failure, COPD exacerbation, cancer, MS, RA, CKD, CAD, recurrent depression, epilepsy, lupus, syncope, cognitive decline Primary Care
- 99214 Established patient — moderate complexity: uncontrolled HTN, diabetes with complications, multiple chronic conditions, COPD, AFib, CKD, sleep apnea, chronic pain, depression Primary Care
- 99215 Established patient — high complexity: HF exacerbation, COPD exacerbation, cancer management, MS, advanced CKD, uncontrolled diabetes, recurrent syncope, respiratory failure, liver cirrhosis Primary Care
- 80053 Comprehensive metabolic panel — diabetes, HTN, CKD, hyperlipidemia, electrolyte disorders, anemia, thyroid, prediabetes, abnormal labs, routine exam, screening Laboratory
- 83036 Hemoglobin A1c — type 2 diabetes, type 1 diabetes, prediabetes, diabetes screening, diabetic kidney disease, diabetic retinopathy Laboratory
- 82947 Glucose quantitative — diabetes, prediabetes, hypoglycemia, diabetes screening, altered consciousness, syncope Laboratory
- 95250 Continuous glucose monitoring — uncontrolled T2DM, uncontrolled T1DM, diabetes management, prediabetes Endocrinology
- 0105U CMS LCD: Billing and Coding: KidneyIntelX and KidneyIntelX.dkd Testing CMS LCD
- 0407U CMS LCD: Billing and Coding: KidneyIntelX and KidneyIntelX.dkd Testing CMS LCD
Convert E11.65 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| E11.65 | 25080 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To E11.65
Other codes in section E08-E13 (Diabetes mellitus).
ICD-10 E11.65, Billing FAQ
Is ICD-10 code E11.65 billable? +
Yes, E11.65 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does E11.65 affect Medicare Advantage HCC risk adjustment? +
Yes. E11.65 maps to CMS-HCC v28 category 18. Capture this diagnosis annually for accurate Medicare Advantage risk score.
What CPT codes are commonly billed with E11.65? +
Procedures frequently paired with E11.65 include: 99215, 99205, 99214, 99215, 80053.
What ICD-9 codes does E11.65 map to? +
Per CMS GEMs, E11.65 maps to ICD-9 codes: 25080. Useful for legacy data review and historical claim analysis.
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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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