G43.E01 ICD-10-CM Code: Chronic migraine with aura, not intractable, with status migrainosus
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the nervous system (G00-G99) / Episodic and paroxysmal disorders (G40-G47)
G43.E01
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceChronic migraine with aura, not intractable, with status migrainosus
A long-term migraine condition with visual disturbances that occurs frequently and is currently in an acute severe phase, but responds to treatment.
Buddy Insight
Chronic migraine with aura represents headache occurring 15 or more days per month for >3 months, with migraine features on at least 8 days AND associated aura symptoms.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 166
RAF 0.100
Code Book Path
Inclusion Terms
Official- Chronic migraine with aura, without refractory migraine
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for G43.E01 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for G43.E01 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for G43.E01 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for G43.E01 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for G43.E01 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for G43.E01 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.E01 an HCC code?
G43.E01 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Migraine under the Part D RxHCC model.
HCC Category Mapping
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.E01 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for G43.E01
For G43.E01to 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.E01 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
G43.E01 is the ICD-10-CM diagnosis code for chronic migraine with aura, not intractable, with status migrainosus. A long-term migraine condition with visual disturbances that occurs frequently and is currently in an acute severe phase, but responds to treatment. G43.E01 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.E01 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.E01 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.E01 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •The '01' suffix indicates status migrainosus (prolonged migraine attack); document the duration and severity
- •Confirm presence of aura symptoms and that the condition is not intractable despite current acute exacerbation
Clinical Significance
Chronic migraine with aura represents headache occurring 15 or more days per month for >3 months, with migraine features on at least 8 days AND associated aura symptoms. The combination of chronicity and aura is clinically significant because aura with high-frequency migraine increases cerebrovascular risk and affects contraceptive choices in women. Accurate coding captures both the chronic pattern and aura presence, which influences treatment decisions including avoidance of estrogen-containing contraceptives.
Documentation Requirements
- ✓Headache frequency >=15 days/month for >3 months documented
- ✓Migraine features present on at least 8 days per month
- ✓Aura symptoms documented: visual (scotoma, fortification spectra), sensory (paresthesias), or speech/language disturbance
- ✓Duration of chronic pattern exceeding 3 months
- ✓Treatment responsiveness documented (not intractable)
- ✓Status migrainosus: single attack lasting >72 hours
- ✓Headache diary or frequency log supporting chronic designation
- ✓Vascular risk assessment given aura presence (especially in women of reproductive age)
Commonly Confused Codes
- •G43.701-G43.719 (Chronic migraine WITHOUT aura): use when chronic pattern exists but no aura symptoms
- •G43.101-G43.119 (Migraine with aura, episodic): use when aura is present but frequency is <15 days/month
- •G43.501-G43.519 (Persistent migraine aura without cerebral infarction): different concept: persistent refers to prolonged single aura, not chronic frequency
- •G44.1 (Vascular headache, NEC): less specific; code to chronic migraine with aura when documented
- •G43.901-G43.919 (Migraine, unspecified): loses both the chronic pattern and aura information