G43.831 ICD-10-CM Code: Menstrual migraine, intractable, with status migrainosus
G43.831 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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)
G43.831
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceMenstrual migraine, intractable, with status migrainosus
Migraine headaches that occur around menstrual periods and do not respond well to treatment, with prolonged migraine symptoms lasting 72 hours or more.
Buddy Insight
Menstrual migraine is a hormonally triggered migraine subtype occurring in relation to the menstrual cycle, typically within 2 days before to 3 days after menstruation onset.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 166
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Menstrual headache, intractableInherited from G43.83
- Menstrual migraine, with refractory migraineInherited from G43.83
- Menstrually related migraine, intractableInherited from G43.83
- Pre-menstrual headache, intractableInherited from G43.83
- Pre-menstrual migraine, intractableInherited from G43.83
- Pure menstrual migraine, intractableInherited from G43.83
Excludes 2
Official- certain conditions originating in the perinatal period (P04-P96)Inherited from G00-G99, G43
- certain infectious and parasitic diseases (A00-B99)Inherited from G00-G99, G43
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from G00-G99, G43
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from G00-G99, G43
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from G00-G99, G43
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from G00-G99, G43
- neoplasms (C00-D49)Inherited from G00-G99, G43
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from G00-G99, G43
- headache NOS (R51.9)Inherited from G00-G99, G43
- headache syndromes (G44.-)Inherited from G00-G99, G43
Related Codes
Includes
OfficialNo Includes notes are included in this display for G43.831. Check the code and parent instructions in the Code Book.
Excludes 1
Official- lower half migraine (G44.00)Inherited from G43
Code First
OfficialNo Code First sequencing instructions are included in this display for G43.831. Check the code and parent instructions in the Code Book.
Use Additional
Official- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)Inherited from G43
Code Also
Official- associated premenstrual tension syndrome (N94.3)Inherited from G43.83
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is G43.831 an HCC code?
G43.831 has no mapping under the current CMS-HCC V28 community payment model. G43.831 has a separate mapping under the Part D RxHCC model (HCC 166 (Migraine Headaches)); the applicable result needs member context.
- Code
- G43.831
- Description
- Menstrual migraine, intractable, with status migrainosus
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work G43.831 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for G43.831
For G43.831, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
Get the V28 mapping + MEAT cheat sheet
One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
G43.831 is the ICD-10-CM diagnosis code for menstrual migraine, intractable, with status migrainosus. Migraine headaches that occur around menstrual periods and do not respond well to treatment, with prolonged migraine symptoms lasting 72 hours or more. G43.831 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).
G43.831 has no mapping under the current CMS-HCC V28 community payment model. G43.831 has a separate mapping under the Part D RxHCC model (HCC 166 (Migraine Headaches)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Intractable means the migraine is resistant to treatment; ensure documentation shows failed treatment attempts.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for G43.831 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Intractable means the migraine is resistant to treatment; ensure documentation shows failed treatment attempts
- •Status migrainosus indicates duration exceeding 72 hours; both conditions must be documented
Clinical Significance
Menstrual migraine is a hormonally triggered migraine subtype occurring in relation to the menstrual cycle, typically within 2 days before to 3 days after menstruation onset. This diagnosis is clinically important because it guides hormone-specific treatment strategies including estrogen supplementation, triptans timed to the menstrual cycle, and contraceptive management. Accurate coding captures the hormonal etiology which affects both treatment planning and pharmacy utilization predictions.
Documentation Requirements
- ✓Temporal relationship to menstrual cycle documented (onset within day -2 to day +3 of menses)
- ✓Pattern occurring in at least 2 out of 3 consecutive menstrual cycles
- ✓Migraine features present (unilateral, pulsating, moderate-severe intensity, nausea/photophobia)
- ✓Distinction between pure menstrual migraine (only perimenstrual) vs. menstrually related migraine (also occurs at other times)
- ✓Intractability status: failed menstrual-specific preventive approaches
- ✓Status migrainosus with episode >72 hours if applicable
- ✓Headache diary correlating attacks with menstrual dates
- ✓Hormonal medication history (oral contraceptives, hormone replacement therapy)
Commonly Confused Codes
- •G43.001-G43.019 (Migraine without aura): use when migraine is not specifically linked to menstrual cycle timing
- •G43.101-G43.119 (Migraine with aura): menstrual migraine typically presents without aura; if aura present, consider dual coding
- •N94.3 (Premenstrual tension syndrome): PMS is not migraine; these are distinct conditions though they may coexist
- •G43.801-G43.819 (Other migraine): menstrual migraine has its own specific codes; do not use 'other'
- •G43.901-G43.919 (Migraine, unspecified): avoid when menstrual pattern is documented