What is ICD-10 code G43.509?

G43.509 is the ICD-10-CM diagnosis code for Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus. A migraine with persistent warning signs (aura) that does not cause stroke, responds to treatment, and is not in a prolonged migraine state. G43.509 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.509 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. G43.509 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. G43.509 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 G43.509?

G43.509 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 G43.509 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 G43.509?

Persistent aura lasting >1 hour after migraine onset should be documented Ensure imaging studies confirm absence of cerebral infarction

G43.509: Persistent migraine aura without cerebral infarction, not intractable, without status

ICD-10-CM Code View

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Code lookupG43.509Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

G43.509

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

Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

A migraine with persistent warning signs (aura) that does not cause stroke, responds to treatment, and is not in a prolonged migraine state.

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

G43.5Persistent migraine aura without cerebral infarction

G43.50Persistent migraine aura without cerebral infarction, not intractable

G43.509Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

Inclusion Terms

Official

Persistent migraine aura NOS

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.509 in this effective period.

Related Child Codes

Official

G43.501Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus

Includes

Official

ICD-10-CM does not list Includes notes for G43.509 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.509 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.509 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.509 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.509 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of prolonged aura symptoms persisting beyond 60 minutes

Specific aura type documented (visual, sensory, speech/language, motor)

Neuroimaging results (MRI preferred) confirming absence of cerebral infarction

Treatment responsiveness documented (not intractable = responds to standard therapy)

MEAT Support

HCC Buddy guidance

Documentation of prolonged aura symptoms persisting beyond 60 minutes

Specific aura type documented (visual, sensory, speech/language, motor)

Neuroimaging results (MRI preferred) confirming absence of cerebral infarction

Treatment responsiveness documented (not intractable = responds to standard therapy)

Audit Caution

HCC Buddy guidance

Coding persistent aura WITH cerebral infarction (G43.6xx) when imaging is negative — always confirm infarction status with imaging

Using standard migraine with aura codes when aura persists beyond 60 minutes — duration is the distinguishing factor

Not documenting the negative imaging findings that confirm absence of infarction

Overlooking status migrainosus when the overall migraine episode exceeds 72 hours

Common Mistakes

HCC Buddy guidance

G43.601-G43.619 (Persistent migraine aura WITH cerebral infarction) — use when imaging confirms actual brain infarction during migraine aura

G43.101-G43.119 (Migraine with aura) — standard aura resolves within 60 minutes; persistent aura does not

G43.401-G43.419 (Hemiplegic migraine) — involves motor weakness specifically, not just prolonged sensory/visual aura

G45.9 (Transient cerebral ischemic attack, unspecified) — TIA is vascular in origin, not migraine-related

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 G43.509 an HCC code?

No. G43.509 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 G43.509

For G43.509to 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 G43.509 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G43.509 is the ICD-10-CM diagnosis code for persistent migraine aura without cerebral infarction, not intractable, without status migrainosus. A migraine with persistent warning signs (aura) that does not cause stroke, responds to treatment, and is not in a prolonged migraine state. G43.509 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).

G43.509 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.

Maps to RxHCC 166 (Severe Head Injury) with a RAF weight of 0.000 in the prescription drug model. Does NOT map to CMS-HCC V28 or V24 payment models, meaning no direct impact on Medicare Advantage capitation payments. The RxHCC mapping captures pharmacy utilization risk. No payment model hierarchies apply to this code.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43.509 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Persistent aura lasting >1 hour after migraine onset should be documented
•Ensure imaging studies confirm absence of cerebral infarction

Clinical Significance

Persistent migraine aura without cerebral infarction represents prolonged aura symptoms (visual, sensory, or speech disturbances) lasting beyond the typical 60-minute duration, without evidence of brain infarction on imaging. This condition requires careful monitoring as it may progress to migrainous infarction and indicates higher neurological risk. Proper coding distinguishes this from migrainous stroke, impacting treatment decisions and follow-up intensity.

Documentation Requirements

✓Documentation of prolonged aura symptoms persisting beyond 60 minutes
✓Specific aura type documented (visual, sensory, speech/language, motor)
✓Neuroimaging results (MRI preferred) confirming absence of cerebral infarction
✓Treatment responsiveness documented (not intractable = responds to standard therapy)
✓Episode duration documented (under 72 hours or absence of status migrainosus)
✓Temporal relationship between aura onset and headache phase
✓Prior history of migraine with aura and any progression pattern

Commonly Confused Codes

•G43.601-G43.619 (Persistent migraine aura WITH cerebral infarction): use when imaging confirms actual brain infarction during migraine aura
•G43.101-G43.119 (Migraine with aura): standard aura resolves within 60 minutes; persistent aura does not
•G43.401-G43.419 (Hemiplegic migraine): involves motor weakness specifically, not just prolonged sensory/visual aura
•G45.9 (Transient cerebral ischemic attack, unspecified): TIA is vascular in origin, not migraine-related
•H53.1 (Subjective visual disturbances): isolated visual symptoms without migraine context

Child Codes

G43.501Persistent migraine aura without cerebral infarction, not intractable, with status migrainosus

G43.509Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

Code Hierarchy

└G43Migraine └G43.5Persistent migraine aura without cerebral infarction └G43.50Persistent migraine aura without cerebral infarction, not intractable └G43.509Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

└G43.509Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

G43.509 ICD-10-CM Code: Persistent migraine aura without cerebral infarction, not intractable, without status migrainosus

HCC Buddy Code Card

G43.509

Is G43.509 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.509

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What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

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