G43.001 ICD-10-CM Code: Migraine without aura, not intractable, with status migrainosus
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G43.001
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMigraine without aura, not intractable, with status migrainosus
Migraine without aura is a common type of headache characterized by throbbing pain, often on one side of the head, sometimes with nausea or sensitivity to light. This code indicates the migraine is controlled with treatment and the patient is experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours.
Buddy Insight
Migraine without aura with status migrainosus identifies a debilitating migraine lasting more than 72 hours continuously.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
MappedHCC 166
RAF 0.0
Code Trumping
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Code Book Path
Inclusion Terms
Official- Migraine without aura without mention of refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.001 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.001 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.001 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.001 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.001 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.001 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is G43.001 an HCC code?
No. G43.001 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work G43.001 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for G43.001
For G43.001to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed G43.001 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G43.001 is the ICD-10-CM diagnosis code for migraine without aura, not intractable, with status migrainosus. Migraine without aura is a common type of headache characterized by throbbing pain, often on one side of the head, sometimes with nausea or sensitivity to light. This code indicates the migraine is controlled with treatment and the patient is experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours. G43.001 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).
G43.001 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing G43.001 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43.001 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Status migrainosus is a serious complication; ensure documentation clearly indicates migraine duration exceeds 72 hours
- •Verify that migraine without aura is confirmed (no visual or sensory symptoms preceding the headache)
Clinical Significance
Migraine without aura with status migrainosus identifies a debilitating migraine lasting more than 72 hours continuously. Status migrainosus is a complication that often requires emergency department visits or hospitalization for intravenous hydration, antiemetics, and parenteral pain management. This condition significantly impacts patient functioning and healthcare resource utilization.
Documentation Requirements
- ✓Confirmed migraine without aura diagnosis (no visual or sensory prodrome)
- ✓Documentation that migraine has lasted continuously for more than 72 hours (status migrainosus)
- ✓Statement that migraines generally respond to treatment (not intractable)
- ✓Treatments attempted and failed during the prolonged episode
- ✓Associated symptoms (nausea, vomiting, photophobia, phonophobia)
- ✓Emergency or inpatient care provided
Commonly Confused Codes
- •G43.009: Migraine without aura, not intractable, WITHOUT status migrainosus; standard migraine episode
- •G43.011: Migraine without aura, INTRACTABLE, with status migrainosus; drug-resistant migraine
- •G43.101: Migraine WITH aura and status migrainosus; has visual/sensory prodrome
- •G43.901: Migraine unspecified with status migrainosus; less specific
- •G44.1: Vascular headache, not elsewhere classified; different headache type