Question 1

What is ICD-10 code G44.209?

Accepted Answer

G44.209 is the ICD-10-CM diagnosis code for tension-type headache, unspecified, not intractable. A tension-type headache of unspecified pattern that responds adequately to treatment or is manageable. G44.209 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).

G44.209 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.

The '9' at the end indicates the headache is not intractable; use when treatment is effective.

Question 2

Is G44.209 an HCC code?

Accepted Answer

No. G44.209 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is G44.209 billable?

Accepted Answer

Yes. G44.209 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. G44.209 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.

Question 4

What is the V28 vs V24 difference for G44.209?

Accepted Answer

G44.209 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 G44.209 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.

Question 5

What should coders know when reporting G44.209?

Accepted Answer

The '9' at the end indicates the headache is not intractable; use when treatment is effective Document the pattern of headaches when possible to use more specific codes (episodic vs. chronic)

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G44.209

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G44.209 ICD-10-CM Code: Tension-type headache, unspecified, not intractable

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G44.209

Is G44.209 an HCC code?

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