What is ICD-10 code G43.D0?

G43.D0 is the ICD-10-CM diagnosis code for Abdominal migraine, not intractable. Recurring episodes of abdominal pain that occur as a migraine variant, typically in children, and responds to standard treatment. It belongs to the ICD-10-CM chapter for diseases of the nervous system (g00-g99). G43.D0 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. G43.D0 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.D0 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.D0 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.

Which HCC does G43.D0 map to under V28?

G43.D0 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

What does G43.D0 pay in RAF?

G43.D0 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

What is the V28 vs V24 difference for G43.D0?

G43.D0 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 community model rewards G43.D0 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Migraine), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What documentation supports G43.D0?

Ensure abdominal symptoms are the primary complaint rather than a secondary symptom of typical migraine The '0' indicates not intractable, so document that treatment is effective G43.D0 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

2026 ICD-10-CM G43.D0: Abdominal migraine, not intractable

G43.D0 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupG43.D0Effective 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.D0

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

Abdominal migraine, not intractable

Recurring episodes of abdominal pain that occur as a migraine variant, typically in children, and responds to standard treatment.

Buddy Insight

Abdominal migraine is a recurrent episodic condition characterized by midline abdominal pain, nausea, and vomiting, primarily affecting children but also occurring in adults.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 166

Migraine

RAF 0.100

Code Book Path

Official

G43Migraine

G43.DAbdominal migraine

G43.D0Abdominal migraine, not intractable

Inclusion Terms

Official

Abdominal migraine, without refractory migraine

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for G43.D0 in this effective period.

Related Child Codes

Official

G43.D1Abdominal migraine, intractable

Includes

Official

ICD-10-CM does not list Includes notes for G43.D0 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for G43.D0 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for G43.D0 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for G43.D0 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for G43.D0 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Recurrent episodes of midline abdominal pain lasting 2-72 hours

Associated symptoms: nausea, vomiting, anorexia, pallor

Symptom-free intervals between episodes (complete return to baseline health)

Exclusion of gastrointestinal, renal, and metabolic causes of recurrent abdominal pain

MEAT Support

HCC Buddy guidance

Recurrent episodes of midline abdominal pain lasting 2-72 hours

Associated symptoms: nausea, vomiting, anorexia, pallor

Symptom-free intervals between episodes (complete return to baseline health)

Exclusion of gastrointestinal, renal, and metabolic causes of recurrent abdominal pain

Audit Caution

HCC Buddy guidance

Coding recurrent abdominal pain as generic R10.x when abdominal migraine is diagnosed — the specific code carries more clinical value

Not documenting exclusion of GI pathology, which is required before diagnosing abdominal migraine

Confusing abdominal migraine with cyclical vomiting syndrome — abdominal pain is the predominant feature in abdominal migraine

Applying this diagnosis without documenting the required episodic pattern with symptom-free intervals

Common Mistakes

HCC Buddy guidance

R10.9 (Unspecified abdominal pain) — non-specific symptom; use abdominal migraine code when diagnosis is established

K58.x (Irritable bowel syndrome) — chronic GI disorder, not episodic with complete symptom-free intervals

R11.15 (Cyclical vomiting syndrome, unrelated to migraine) — vomiting-predominant without abdominal pain focus

G43.A0-G43.A1 (Cyclical vomiting in migraine) — vomiting-predominant migraine variant vs. pain-predominant abdominal migraine

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.D0 an HCC code?

G43.D0 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Migraine under the Part D RxHCC model.

Code: G43.D0
Description: Abdominal migraine, not intractable
HCC (V28): No CMS-HCC V28 mapping
RAF: —
Billable: Yes
Payment year: 2026

HCC Category Mapping

RxHCCHCC 166, Migraine

0.100

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.D0 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for G43.D0

For G43.D0 to 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.D0 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

G43.D0 is the ICD-10-CM diagnosis code for abdominal migraine, not intractable. Recurring episodes of abdominal pain that occur as a migraine variant, typically in children, and responds to standard treatment. G43.D0 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.D0 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.D0 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.D0 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Ensure abdominal symptoms are the primary complaint rather than a secondary symptom of typical migraine
•The '0' indicates not intractable, so document that treatment is effective

Clinical Significance

Abdominal migraine is a recurrent episodic condition characterized by midline abdominal pain, nausea, and vomiting, primarily affecting children but also occurring in adults. It is recognized as a migraine variant and often precedes development of typical migraine headaches later in life. Accurate coding prevents unnecessary gastrointestinal workups and directs treatment toward migraine-specific therapies.

Documentation Requirements

✓Recurrent episodes of midline abdominal pain lasting 2-72 hours
✓Associated symptoms: nausea, vomiting, anorexia, pallor
✓Symptom-free intervals between episodes (complete return to baseline health)
✓Exclusion of gastrointestinal, renal, and metabolic causes of recurrent abdominal pain
✓Family history of migraine (supports diagnosis)
✓Stereotypical pattern to episodes (similar presentation each time)
✓Treatment response noted (not intractable)
✓At least 2 episodes meeting diagnostic criteria

Commonly Confused Codes

•R10.9 (Unspecified abdominal pain): non-specific symptom; use abdominal migraine code when diagnosis is established
•K58.x (Irritable bowel syndrome): chronic GI disorder, not episodic with complete symptom-free intervals
•R11.15 (Cyclical vomiting syndrome, unrelated to migraine): vomiting-predominant without abdominal pain focus
•G43.A0-G43.A1 (Cyclical vomiting in migraine): vomiting-predominant migraine variant vs. pain-predominant abdominal migraine
•K59.8 (Other specified functional intestinal disorders): functional GI disorders lack the episodic migraine pattern

Child Codes

G43.D0Abdominal migraine, not intractable

G43.D1Abdominal migraine, intractable

Code Hierarchy

└G43Migraine └G43.DAbdominal migraine └G43.D0Abdominal migraine, not intractable

└G43.D0Abdominal migraine, not intractable

G43.D0 ICD-10-CM Code: Abdominal migraine, not intractable

HCC Buddy Code Card

G43.D0

Is G43.D0 an HCC code?

HCC Category Mapping

MEAT Criteria for G43.D0

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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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