G43.109 ICD-10-CM Code: Migraine with aura, not intractable, without 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)
G43.109
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMigraine with aura, not intractable, without status migrainosus
A migraine with warning signs (aura) that responds to treatment and is not in a prolonged migraine state.
Buddy Insight
Migraine with aura, medication-responsive, without status migrainosus is the standard presentation of classic migraine.
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 with aura NOS
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.109 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.109 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.109 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.109 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.109 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.109 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 G43.109 an HCC code?
No. G43.109 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.
MEAT Criteria for G43.109
For G43.109to 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 G43.109 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
G43.109 is the ICD-10-CM diagnosis code for migraine with aura, not intractable, without status migrainosus. A migraine with warning signs (aura) that responds to treatment and is not in a prolonged migraine state. G43.109 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).
G43.109 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 G43.109 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 G43.109 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is the most common migraine with aura presentation
- •Verify that documentation confirms the migraine is responsive to treatment (not intractable)
Clinical Significance
Migraine with aura, medication-responsive, without status migrainosus is the standard presentation of classic migraine. The aura phase typically involves visual phenomena (scintillating scotoma, zigzag lines), sensory symptoms, or speech difficulties lasting 5-60 minutes before headache onset. Migraine with aura carries a slightly increased stroke risk, particularly in women using estrogen-containing contraceptives.
Documentation Requirements
- ✓Confirmed migraine with aura diagnosis
- ✓Description of aura type and duration (visual, sensory, speech disturbance)
- ✓Seizure control — responding to treatment (not intractable)
- ✓Absence of status migrainosus (episodes <72 hours)
- ✓Current acute and preventive treatment regimen
- ✓Assessment of stroke risk factors if applicable (smoking, oral contraceptive use)
Commonly Confused Codes
- •G43.101: Migraine with aura WITH status migrainosus; >72 hours continuous
- •G43.119: Migraine with aura, INTRACTABLE; drug-resistant
- •G43.009: Migraine WITHOUT aura; no visual/sensory prodrome
- •G43.809: Other migraine, not intractable; hemiplegic, retinal, or other subtypes
- •G45.9: Transient cerebral ischemic attack; important differential diagnosis