What is ICD-10 code G43.019?

G43.019 is the ICD-10-CM diagnosis code for Migraine without aura, intractable, without status migrainosus. A severe, difficult-to-treat migraine headache without warning signs (aura) that does not progress to a prolonged migraine state. It belongs to the ICD-10-CM chapter for diseases of the nervous system (g00-g99). G43.019 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.019 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. G43.019 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. G43.019 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 G43.019?

G43.019 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 model rewards G43.019 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

What should coders know when reporting G43.019?

Intractable means the migraine is resistant to treatment; ensure documentation supports this severity level The '9' indicates no status migrainosus (prolonged migraine lasting >72 hours)

G43.019: Migraine without aura, intractable, without status migrainosus — ICD-10

ICD-10-CM Code View

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Code lookupG43.019Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

G43.019

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

Migraine without aura, intractable, without status migrainosus

A severe, difficult-to-treat migraine headache without warning signs (aura) that does not progress to a prolonged migraine state.

Buddy Insight

Migraine without aura, intractable, without status migrainosus identifies patients with drug-resistant migraines that do not reach the 72-hour continuous threshold.

CMS-HCC V28

Not risk-adjusted for this model/period.

RAF 0

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 166

Migraine

RAF 0.0

Code Trumping

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Code Book Path

Official

G43.0Migraine without aura

G43.01Migraine without aura, intractable

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

Inclusion Terms

Official

Migraine without aura with refractory migraine

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.019 in this effective period.

Related Child Codes

Official

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

Includes

Official

ICD-10-CM does not list Includes notes for G43.019 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.019 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.019 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.019 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.019 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Confirmed migraine without aura diagnosis

Documentation of intractability with failed medication trials

Absence of status migrainosus (episodes <72 hours)

List of preventive and acute medications tried and failed

MEAT Support

HCC Buddy guidance

Confirmed migraine without aura diagnosis

Documentation of intractability with failed medication trials

Absence of status migrainosus (episodes <72 hours)

List of preventive and acute medications tried and failed

Audit Caution

HCC Buddy guidance

Not distinguishing intractable migraine from medication overuse headache

Coding intractable without documentation of adequate failed medication trials

Using this code when chronic migraine (G43.709+) more accurately describes the pattern

Failing to recognize that some 'intractable' migraines respond to newer CGRP-targeted therapies

Common Mistakes

HCC Buddy guidance

G43.009 — Migraine without aura, NOT intractable; responds to treatment

G43.011 — Migraine without aura, intractable, WITH status migrainosus

G43.119 — Migraine WITH aura, intractable; has aura symptoms

G43.709 — Chronic migraine without aura, not intractable; different frequency pattern

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 G43.019 an HCC code?

No. G43.019 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

HCC Category Mapping

RxHCCHCC 166, Migraine

0.000

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.

MEAT Criteria for G43.019

For G43.019to 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 G43.019 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G43.019 is the ICD-10-CM diagnosis code for migraine without aura, intractable, without status migrainosus. A severe, difficult-to-treat migraine headache without warning signs (aura) that does not progress to a prolonged migraine state. G43.019 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).

G43.019 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 any HCC in V28 or V24 models (null mapping). Maps to RxHCC 166 (Severe Head Injury) in the prescription drug model only. No RAF weight contribution in Medicare Advantage risk adjustment. Coders reviewing G43.019 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 G43.019 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Intractable means the migraine is resistant to treatment; ensure documentation supports this severity level
•The '9' indicates no status migrainosus (prolonged migraine lasting >72 hours)

Clinical Significance

Migraine without aura, intractable, without status migrainosus identifies patients with drug-resistant migraines that do not reach the 72-hour continuous threshold. These patients have chronic, difficult-to-treat migraines that significantly impact quality of life and productivity. They may be candidates for newer therapies including CGRP monoclonal antibodies, neuromodulation devices, or Botox injections.

Documentation Requirements

✓Confirmed migraine without aura diagnosis
✓Documentation of intractability with failed medication trials
✓Absence of status migrainosus (episodes <72 hours)
✓List of preventive and acute medications tried and failed
✓Migraine frequency (number of headache days per month)
✓Functional impact assessment
✓Current or planned treatment including newer targeted therapies

Commonly Confused Codes

•G43.009: Migraine without aura, NOT intractable; responds to treatment
•G43.011: Migraine without aura, intractable, WITH status migrainosus
•G43.119: Migraine WITH aura, intractable; has aura symptoms
•G43.709: Chronic migraine without aura, not intractable; different frequency pattern
•G44.41: Drug-induced headache; medication overuse can 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 └G43.019Migraine without aura, intractable, without status migrainosus

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

G43.019 ICD-10-CM Code: Migraine without aura, intractable, without status migrainosus

HCC Buddy Code Card

G43.019

Is G43.019 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.019

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What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

Work G43.019 in HCC Buddy