G43

Migraine

Header / non-billable

This code does not map to a risk-adjusting HCC in the loaded models.

Coding notes

Excludes 1 never coded together · Excludes 2 may co-exist

This code · G43
Excludes 1

lower half migraine (G44.00)

Excludes 2

headache NOS (R51.9) headache syndromes (G44.-)

Use additional

code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Note

the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled

Inherited from chapter 6Diseases of the nervous system
Excludes 2

certain conditions originating in the perinatal period (P04-P96) certain infectious and parasitic diseases (A00-B99) complications of pregnancy, childbirth and the puerperium (O00-O9A) congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99) endocrine, nutritional and metabolic diseases (E00-E88) injury, poisoning and certain other consequences of external causes (S00-T88) neoplasms (C00-D49) symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)

Official Guidelines for G43

FY 2026 ›