What is ICD-10 code G43.011?

G43.011 is the ICD-10-CM diagnosis code for Migraine without aura, intractable, with status migrainosus. Migraine without aura that does not respond adequately to standard migraine treatments, with the patient experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours. G43.011 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.011 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. G43.011 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. G43.011 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for G43.011?

G43.011 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards G43.011 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Migraine), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What should coders know when reporting G43.011?

Document intractability and confirm status migrainosus (migraine duration exceeding 72 hours) Status migrainosus may require hospitalization; ensure acute care documentation is included

2026 ICD-10-CM G43.011: Migraine without aura, intractable

ICD-10-CM Code View

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Code lookupG43.011Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)

G43.011

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Migraine without aura, intractable, with status migrainosus

Migraine without aura that does not respond adequately to standard migraine treatments, with the patient experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours.

Buddy Insight

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 166

Migraine

RAF 0.100

Code Book Path

Official

G43.0Migraine without aura

G43.01Migraine without aura, intractable

G43.011Migraine without aura, intractable, with status migrainosus

Inclusion Terms

Official

Migraine without aura with refractory migraine

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.011 in this effective period.

Related Child Codes

Official

G43.019Migraine without aura, intractable, without status migrainosus

Includes

Official

ICD-10-CM does not list Includes notes for G43.011 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.011 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.011 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.011 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.011 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Confirmed migraine without aura diagnosis

Documentation of intractability (failed adequate trials of preventive and acute medications)

Status migrainosus documented with migraine duration exceeding 72 hours

List of medications tried and failed

MEAT Support

HCC Buddy guidance

Confirmed migraine without aura diagnosis

Documentation of intractability (failed adequate trials of preventive and acute medications)

Status migrainosus documented with migraine duration exceeding 72 hours

List of medications tried and failed

Audit Caution

HCC Buddy guidance

Coding intractable when migraines are actually caused by medication overuse (G44.41)

Not verifying that both intractability AND >72-hour duration are documented

Using this code for severe but brief migraines that do not meet the 72-hour threshold

Failing to distinguish between a single intractable episode and a pattern of intractable migraines

Common Mistakes

HCC Buddy guidance

G43.001 — Migraine without aura with status migrainosus, NOT intractable

G43.019 — Migraine without aura, intractable, WITHOUT status migrainosus

G43.111 — Migraine WITH aura, intractable, with status migrainosus; has aura symptoms

G43.901 — Unspecified migraine with status migrainosus; less specific

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is G43.011 an HCC code?

G43.011 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Migraine under the Part D RxHCC model.

Code: G43.011
Description: Migraine without aura, intractable, with status migrainosus
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 166, Migraine

0.100

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. 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 G43.011 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for G43.011

For G43.011 to 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 G43.011 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G43.011 is the ICD-10-CM diagnosis code for migraine without aura, intractable, with status migrainosus. Migraine without aura that does not respond adequately to standard migraine treatments, with the patient experiencing status migrainosus, which is a prolonged migraine lasting more than 72 hours. G43.011 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).

G43.011 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 G43.011 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 G43.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document intractability and confirm status migrainosus (migraine duration exceeding 72 hours)
•Status migrainosus may require hospitalization; ensure acute care documentation is included

Clinical Significance

Migraine without aura, intractable, with status migrainosus represents the most severe presentation of this migraine type — drug-resistant migraines that have progressed to a continuous state lasting over 72 hours. These patients often require hospitalization, IV medications, and may need nerve blocks or other interventional procedures. This combination indicates very high healthcare resource utilization.

Documentation Requirements

✓Confirmed migraine without aura diagnosis
✓Documentation of intractability (failed adequate trials of preventive and acute medications)
✓Status migrainosus documented with migraine duration exceeding 72 hours
✓List of medications tried and failed
✓Inpatient or emergency treatment provided
✓Assessment for medication overuse headache as contributing factor

Commonly Confused Codes

•G43.001: Migraine without aura with status migrainosus, NOT intractable
•G43.019: Migraine without aura, intractable, WITHOUT status migrainosus
•G43.111: Migraine WITH aura, intractable, with status migrainosus; has aura symptoms
•G43.901: Unspecified migraine with status migrainosus; less specific
•G44.41: Drug-induced headache; medication overuse may mimic intractable migraine

Child Codes

G43.011Migraine without aura, intractable, with status migrainosus

G43.019Migraine without aura, intractable, without status migrainosus

Code Hierarchy

└G43Migraine └G43.0Migraine without aura └G43.01Migraine without aura, intractable └G43.011Migraine without aura, intractable, with status migrainosus

└G43.011Migraine without aura, intractable, with status migrainosus

G43.011 ICD-10-CM Code: Migraine without aura, intractable, with status migrainosus

HCC Buddy Code Card

G43.011

Is G43.011 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.011

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

Work G43.011 in HCC Buddy