G43.119 ICD-10-CM Code: Migraine with aura, intractable, without status migrainosus
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G43.119
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMigraine with aura, intractable, without status migrainosus
A severe, difficult-to-treat migraine with warning signs (aura) that does not progress to a prolonged migraine state.
Buddy Insight
Migraine with aura, intractable, without status migrainosus captures patients with drug-resistant classic migraines that do not extend beyond 72 hours.
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
Basket needed
Code Book Path
Inclusion Terms
Official- Migraine with aura with refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.119 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.119 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.119 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.119 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.119 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.119 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 G43.119 an HCC code?
No. G43.119 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 G43.119
For G43.119to 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 G43.119 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
G43.119 is the ICD-10-CM diagnosis code for migraine with aura, intractable, without status migrainosus. A severe, difficult-to-treat migraine with warning signs (aura) that does not progress to a prolonged migraine state. G43.119 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).
G43.119 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 G43.119 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 G43.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intractable migraines with aura require documentation of failed treatment attempts
- •The '9' indicates absence of status migrainosus
Clinical Significance
Migraine with aura, intractable, without status migrainosus captures patients with drug-resistant classic migraines that do not extend beyond 72 hours. These patients experience frequent, difficult-to-treat migraines preceded by aura and have failed standard preventive and acute treatments. They are candidates for advanced migraine therapies including CGRP inhibitors, neuromodulation, and Botox injections.
Documentation Requirements
- ✓Confirmed migraine with aura diagnosis with aura type description
- ✓Documentation of intractability with list of failed medications
- ✓Absence of status migrainosus (episodes not exceeding 72 hours)
- ✓Migraine frequency and headache days per month
- ✓Functional impact and disability assessment (MIDAS score or similar)
- ✓Current and planned treatment approaches
Commonly Confused Codes
- •G43.109: Migraine with aura, NOT intractable; responds to treatment
- •G43.111: Migraine with aura, intractable, WITH status migrainosus
- •G43.019: Migraine WITHOUT aura, intractable; no visual/sensory prodrome
- •G43.719: Chronic migraine without aura, intractable; different pattern classification
- •G44.41: Drug-induced headache; medication overuse mimicking intractable migraine