G43.101 ICD-10-CM Code: Migraine with 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)
G43.101
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMigraine with aura, not intractable, with status migrainosus
A migraine with warning signs (aura) that responds to treatment but is currently in a prolonged migraine state lasting more than 72 hours.
Buddy Insight
Migraine with aura and status migrainosus involves a migraine preceded by visual, sensory, or speech disturbances that has progressed to a continuous state lasting over 72 hours.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 166
RAF 0.100
Code Book Path
Inclusion Terms
Official- Migraine with aura without mention of refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.101 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.101 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.101 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.101 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.101 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.101 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 G43.101 an HCC code?
G43.101 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
- G43.101
- Description
- Migraine with aura, not intractable, with status migrainosus
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 G43.101 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for G43.101
For G43.101 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 G43.101 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G43.101 is the ICD-10-CM diagnosis code for migraine with aura, not intractable, with status migrainosus. A migraine with warning signs (aura) that responds to treatment but is currently in a prolonged migraine state lasting more than 72 hours. G43.101 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).
G43.101 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 G43.101 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 G43.101 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Status migrainosus is a medical emergency; ensure this condition is clearly documented in the medical record
- •Not intractable means the migraine typically responds to standard treatments despite current status
Clinical Significance
Migraine with aura and status migrainosus involves a migraine preceded by visual, sensory, or speech disturbances that has progressed to a continuous state lasting over 72 hours. The aura component is clinically significant because it may mimic stroke or transient ischemic attack symptoms, requiring careful differential diagnosis. Status migrainosus in this context often necessitates emergency or inpatient management.
Documentation Requirements
- ✓Confirmed migraine with aura diagnosis with description of aura type (visual, sensory, speech)
- ✓Status migrainosus documented with continuous migraine duration exceeding 72 hours
- ✓Statement that migraines generally respond to treatment (not intractable)
- ✓Differentiation from stroke or transient ischemic attack documented
- ✓Emergency or inpatient treatments provided
- ✓Associated symptoms and functional impact
Commonly Confused Codes
- •G43.109: Migraine with aura, not intractable, WITHOUT status migrainosus
- •G43.111: Migraine with aura, INTRACTABLE, with status migrainosus
- •G43.001: Migraine WITHOUT aura with status migrainosus; no visual/sensory prodrome
- •G43.501: Persistent migraine aura with cerebral infarction; actual stroke occurring with migraine
- •G45.9: Transient cerebral ischemic attack; may mimic migraine aura