G43.519 ICD-10-CM Code: Persistent migraine aura without cerebral infarction, intractable, without status migrainosus
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G43.519
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidancePersistent migraine aura without cerebral infarction, intractable, without status migrainosus
A severe, difficult-to-treat migraine with persistent warning signs (aura) that does not cause stroke and does not progress to a prolonged migraine state.
Buddy Insight
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.
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- Persistent migraine aura without cerebral infarction, with refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.519 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.519 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.519 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.519 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.519 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.519 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 G43.519 an HCC code?
No. G43.519 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.
Work G43.519 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for G43.519
For G43.519to 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 G43.519 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G43.519 is the ICD-10-CM diagnosis code for persistent migraine aura without cerebral infarction, intractable, without status migrainosus. A severe, difficult-to-treat migraine with persistent warning signs (aura) that does not cause stroke and does not progress to a prolonged migraine state. G43.519 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).
G43.519 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 G43.519 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 G43.519 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intractable persistent aura migraines are rare; document failed treatment attempts thoroughly
- •Neuroimaging should be documented to confirm no 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
- ✓Intractability status clearly stated by provider
- ✓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