What is ICD-10 code G43.111?

G43.111 is the ICD-10-CM diagnosis code for Migraine with aura, intractable, with status migrainosus. It belongs to the ICD-10-CM chapter for diseases of the nervous system (g00-g99). G43.111 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.111 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. G43.111 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. G43.111 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 G43.111?

G43.111 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 G43.111 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 G43.111?

Verify documentation clearly states both 'intractable' (drug-resistant) and 'status migrainosus' (prolonged migraine state) before assigning this code, as both conditions must be present Status migrainosus is a serious complication requiring hospitalization; ensure the clinical record supports the severity and duration of symptoms to justify this high-specificity code

G43.111: Migraine with aura, intractable

ICD-10-CM Code View

HCC Buddy Code Card

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Code lookupG43.111Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

G43.111

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

Migraine with aura, intractable, with status migrainosus

This is a severe migraine headache with visual or sensory warning signs (aura) that does not respond to standard treatment and has progressed into a prolonged migraine state lasting more than 72 hours. The patient experiences persistent migraine symptoms despite medication attempts.

Buddy Insight

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

G43.1Migraine with aura

G43.11Migraine with aura, intractable

G43.111Migraine with aura, intractable, with status migrainosus

Inclusion Terms

Official

Migraine with aura with refractory migraine

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.111 in this effective period.

Related Child Codes

Official

G43.119Migraine with aura, intractable, without status migrainosus

Includes

Official

ICD-10-CM does not list Includes notes for G43.111 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.111 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.111 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.111 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.111 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Confirmed migraine with aura diagnosis with aura description

Documentation of intractability with failed preventive and acute medication trials

Status migrainosus documented with duration exceeding 72 hours

Hospitalization or emergency department documentation

MEAT Support

HCC Buddy guidance

Confirmed migraine with aura diagnosis with aura description

Documentation of intractability with failed preventive and acute medication trials

Status migrainosus documented with duration exceeding 72 hours

Hospitalization or emergency department documentation

Audit Caution

HCC Buddy guidance

Not verifying all three components: aura, intractability, and >72-hour duration

Confusing prolonged aura with status migrainosus — they are different complications

Coding intractable when the current episode is simply severe but migraines normally respond to treatment

Not screening for medication overuse headache which commonly accompanies intractable migraine

Common Mistakes

HCC Buddy guidance

G43.101 — Migraine with aura, NOT intractable, with status migrainosus

G43.119 — Migraine with aura, intractable, WITHOUT status migrainosus

G43.011 — Migraine WITHOUT aura, intractable, with status migrainosus

G43.501 — Persistent migraine aura with cerebral infarction; stroke complication

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 G43.111 an HCC code?

No. G43.111 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 G43.111

For G43.111to 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 G43.111 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

G43.111 is the ICD-10-CM diagnosis code for migraine with aura, intractable, with status migrainosus. This is a severe migraine headache with visual or sensory warning signs (aura) that does not respond to standard treatment and has progressed into a prolonged migraine state lasting more than 72 hours. The patient experiences persistent migraine symptoms despite medication attempts. G43.111 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).

G43.111 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 despite high clinical severity and resource utilization.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43.111 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation clearly states both 'intractable' (drug-resistant) and 'status migrainosus' (prolonged migraine state) before assigning this code, as both conditions must be present
•Status migrainosus is a serious complication requiring hospitalization; ensure the clinical record supports the severity and duration of symptoms to justify this high-specificity code

Clinical Significance

Migraine with aura, intractable, with status migrainosus is the most severe presentation of classic migraine — drug-resistant migraines with aura that have progressed to a continuous state exceeding 72 hours. This clinical scenario often requires hospitalization with aggressive IV treatment protocols. The combination of drug resistance and prolonged duration indicates a complex headache patient requiring specialist management.

Documentation Requirements

✓Confirmed migraine with aura diagnosis with aura description
✓Documentation of intractability with failed preventive and acute medication trials
✓Status migrainosus documented with duration exceeding 72 hours
✓Hospitalization or emergency department documentation
✓Complete medication history showing drug resistance
✓Treatment plan including interventional options (nerve blocks, IV protocols)

Commonly Confused Codes

•G43.101: Migraine with aura, NOT intractable, with status migrainosus
•G43.119: Migraine with aura, intractable, WITHOUT status migrainosus
•G43.011: Migraine WITHOUT aura, intractable, with status migrainosus
•G43.501: Persistent migraine aura with cerebral infarction; stroke complication
•G43.601: Persistent migraine aura without cerebral infarction; aura >60 minutes

Child Codes

G43.111Migraine with aura, intractable, with status migrainosus

G43.119Migraine with aura, intractable, without status migrainosus

Code Hierarchy

└G43Migraine └G43.1Migraine with aura └G43.11Migraine with aura, intractable └G43.111Migraine with aura, intractable, with status migrainosus

└G43.111Migraine with aura, intractable, with status migrainosus

G43.111 ICD-10-CM Code: Migraine with aura, intractable, with status migrainosus

HCC Buddy Code Card

G43.111

Is G43.111 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.111

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

Work G43.111 in HCC Buddy