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G43

Non-Billable (Header)

Migraine

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

What This Code Means

G43 is the ICD-10-CM diagnosis code for migraine. G43 sits in the ICD-10-CM chapter for diseases of the nervous system (g00-g99), within the section covering episodic and paroxysmal disorders (g40-g47).

Header codes like G43 cannot be reported on claims directly — they organize child codes that share clinical context but the actual diagnosis must be coded to the highest level of specificity supported by the documentation. Coders should look at G43's child codes and select the one that matches the patient's documented presentation, since payers reject header codes submitted as the primary diagnosis. For risk adjustment workflows, header codes never contribute to a Medicare Advantage member's RAF score on their own; only billable child codes that happen to map to a payment HCC affect risk-adjusted plan payments.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Excludes 1 — Do NOT code together

Excludes 2 — Not included here, may code separately

  • headache syndromes (G44.-)

Use Additional Code

  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Child Codes

Code Hierarchy

G43Migraine
G43Migraine

More on G43

Referenced in blog posts

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