What is ICD-10 code G43.711?

G43.711 is the ICD-10-CM diagnosis code for Chronic migraine without aura, intractable, with status migrainosus. A long-term migraine condition without visual disturbances that is difficult to treat and does not respond well to standard medications, and the patient is currently experiencing a prolonged migraine attack. G43.711 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.711 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. G43.711 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. G43.711 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 G43.711?

G43.711 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 G43.711 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 G43.711?

Document failed treatment attempts with multiple preventive and acute migraine medications to justify 'intractable' designation. The '11' suffix indicates intractable with status migrainosus; verify the continuous migraine has lasted >72 hours.

G43.711: Chronic migraine without aura, intractable, with status migrainosus — ICD-10

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupG43.711Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

G43.711

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

Chronic migraine without aura, intractable, with status migrainosus

A long-term migraine condition without visual disturbances that is difficult to treat and does not respond well to standard medications, and the patient is currently experiencing a prolonged migraine attack.

Buddy Insight

Chronic migraine without aura is defined as headache occurring on 15 or more days per month for more than 3 months, with migraine features on at least 8 days.

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

Basket needed

Compare selected patient codes to show trumped or trumps impact.

Code Book Path

Official

G43.7Chronic migraine without aura

G43.71Chronic migraine without aura, intractable

G43.711Chronic migraine without aura, intractable, with status migrainosus

Inclusion Terms

Official

Chronic migraine without aura, with refractory migraine

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.711 in this effective period.

Related Child Codes

Official

G43.719Chronic migraine without aura, intractable, without status migrainosus

Includes

Official

ICD-10-CM does not list Includes notes for G43.711 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.711 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.711 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.711 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.711 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Headache frequency documented: 15 or more headache days per month for >3 months

At least 8 days per month meeting migraine criteria (unilateral, pulsating, moderate-severe, aggravated by activity)

Absence of aura symptoms clearly stated (no visual, sensory, or speech disturbances preceding headache)

Duration of chronic pattern documented (must exceed 3 months)

MEAT Support

HCC Buddy guidance

Headache frequency documented: 15 or more headache days per month for >3 months

At least 8 days per month meeting migraine criteria (unilateral, pulsating, moderate-severe, aggravated by activity)

Absence of aura symptoms clearly stated (no visual, sensory, or speech disturbances preceding headache)

Duration of chronic pattern documented (must exceed 3 months)

Audit Caution

HCC Buddy guidance

Coding episodic migraine (G43.0xx) when headache diary shows >=15 days/month — frequency determines chronicity

Not addressing medication overuse headache (G44.4x) which commonly coexists and should be coded separately

Assuming 'chronic' based on years of history rather than current headache frequency — chronic migraine is defined by current frequency pattern

Failing to distinguish intractable (refractory to treatment) from merely severe or frequent episodes

Common Mistakes

HCC Buddy guidance

G43.001-G43.019 (Migraine without aura, episodic) — fewer than 15 headache days/month; chronic requires >=15 days

G43.E01-G43.E19 (Chronic migraine WITH aura) — use when aura symptoms are present with chronic pattern

G44.1 (Vascular headache, not elsewhere classified) — non-specific; always code to specific migraine type when documented

G44.209-G44.229 (Tension-type headache) — different headache characteristics; migraine has specific qualifying features

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 G43.711 an HCC code?

No. G43.711 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.

Work G43.711 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for G43.711

For G43.711to 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 G43.711 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

G43.711 is the ICD-10-CM diagnosis code for chronic migraine without aura, intractable, with status migrainosus. A long-term migraine condition without visual disturbances that is difficult to treat and does not respond well to standard medications, and the patient is currently experiencing a prolonged migraine attack. G43.711 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).

G43.711 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. No mapping to CMS-HCC V28 or V24 payment models. The RxHCC mapping reflects the significant pharmacy costs associated with chronic migraine (preventive medications, triptans, CGRP inhibitors). No hierarchies apply in payment models.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for G43.711 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document failed treatment attempts with multiple preventive and acute migraine medications to justify 'intractable' designation.
•The '11' suffix indicates intractable with status migrainosus; verify the continuous migraine has lasted >72 hours.

Clinical Significance

Chronic migraine without aura is defined as headache occurring on 15 or more days per month for more than 3 months, with migraine features on at least 8 days. This high-frequency condition significantly impacts quality of life and healthcare utilization, often requiring preventive medications and specialist management. Accurate coding captures the chronicity that differentiates this from episodic migraine and supports appropriate treatment authorization.

Documentation Requirements

✓Headache frequency documented: 15 or more headache days per month for >3 months
✓At least 8 days per month meeting migraine criteria (unilateral, pulsating, moderate-severe, aggravated by activity)
✓Absence of aura symptoms clearly stated (no visual, sensory, or speech disturbances preceding headache)
✓Duration of chronic pattern documented (must exceed 3 months)
✓Intractability status: failed adequate trials of preventive medications
✓Status migrainosus: single attack duration >72 hours documented
✓Medication overuse headache excluded or addressed (common comorbidity)
✓Headache diary or frequency log referenced

Commonly Confused Codes

•G43.001-G43.019 (Migraine without aura, episodic): fewer than 15 headache days/month; chronic requires >=15 days
•G43.E01-G43.E19 (Chronic migraine WITH aura): use when aura symptoms are present with chronic pattern
•G44.1 (Vascular headache, not elsewhere classified): non-specific; always code to specific migraine type when documented
•G44.209-G44.229 (Tension-type headache): different headache characteristics; migraine has specific qualifying features
•G43.901-G43.919 (Migraine, unspecified): avoid when chronic pattern and aura status are documented

Child Codes

G43.711Chronic migraine without aura, intractable, with status migrainosus

G43.719Chronic migraine without aura, intractable, without status migrainosus

Code Hierarchy

└G43Migraine └G43.7Chronic migraine without aura └G43.71Chronic migraine without aura, intractable └G43.711Chronic migraine without aura, intractable, with status migrainosus

└G43.711Chronic migraine without aura, intractable, with status migrainosus

G43.711 ICD-10-CM Code: Chronic migraine without aura, intractable, with status migrainosus

HCC Buddy Code Card

G43.711

Is G43.711 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.711

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

Work G43.711 in HCC Buddy