2027 ICD-10-CM Diagnosis Code G43.E11Chronic migraine with aura, intractable, with status migrainosus

ICD-10-CM Codes›G00–G99›G40-G47›G43

ICD-10-CM G43.E11
CMSSource: CMS FY 2027 ICD-10-CM dataset · Effective Oct 1, 2026 – Sep 30, 2027

G43.E11 is a billable ICD-10-CM diagnosis code for chronic migraine with aura, intractable, with status migrainosus. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 102 through 103. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Headache; including migraine.

G43.E11 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 166 for payment year 2027.

Code Identity

ICD-10-CM Code
G43.E11
Billable Status
Yes — Valid for Submission
Code Describes
Chronic migraine with aura, intractable, with status migrainosus
Short Description
Chronic migraine with aura, intractable, with stat migr
Parent Code
G43.E1
Chronic migraine with aura, intractable

Code Classification

ChapterG00–G99Diseases of the nervous system
SectionG40-G47Episodic and paroxysmal disorders
CategoryG43Migraine
This CodeG43.E11Chronic migraine with aura, intractable, with status migrainosus

Medicare Risk Adjustment (HCC)Billing

G43.E11 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.

CMS-HCC V28 (Medicare Advantage Payment Model)
Not mapped
no payment category in the model that pays 100% of MA risk scores
Prior Model (CMS-HCC V24)
Not mapped under V24
this diagnosis newly risk-adjusts under the V28 model
Part D (RxHCC)
RxHCC 166 — Migraine Headaches
also risk-adjusts in the Part D prescription drug model (V08)

Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.

Instructional NotesGuidance

Instructions from the official ICD-10-CM Tabular List that apply to G43.E11: its own notes plus those printed at G43.E, G43, and Chapter 6. A note printed at a category, block or chapter applies to every code under it.

Excludes1

Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.

From G43.E Chronic migraine with aura applies to 4 codes
From G43 Migraine applies to 48 codes

Excludes2

Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.

From G43 Migraine applies to 48 codes
From Chapter 6 (G00-G99) Diseases of the nervous system applies to 700 codes
  • 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)

Use Additional Code

Add a second code, after this one, to fully describe the condition.

From G43 Migraine applies to 48 codes
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)

Notes

General instructions on how these codes are used.

From G43 Migraine applies to 48 codes
  • the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled

Source: CMS ICD-10-CM Tabular List. How to read instructional notes.

Referenced in Other NotesGuidance

Instructional notes printed at other codes that name G43.E11, its category, or a range that includes it.

Excludes1 1

These codes carry an Excludes1 note naming G43.E11: they are not reported together with it, unless the two conditions are unrelated.

  • G43.1 Migraine with aura
    chronic migraine with aura (G43.E-) names G43.E-, which includes this code

Excludes2 4

These codes carry an Excludes2 note naming G43.E11: its condition is not part of those codes, and both may be reported when the patient has both.

  • G44 Other headache syndromes
    migraines (G43.-) names G43.-, which includes this code
  • G44.1 Vascular headache, not elsewhere classified
    migraine (G43.-) names G43.-, which includes this code
  • G89 Pain, not elsewhere classified
    migraines (G43.-) names G43.-, which includes this code
  • R51 Headache
    migraine and other headache syndromes (G43-G44) names G43-G44, which includes this code

Index to Diseases and InjuriesGuidance

Alphabetical index entries that point to this code.

Clinical ClassificationClinical

AHRQ’s CCSR groups this code into broader clinical categories.

CCSR NVS010
Headache; including migraine
Default principal diagnosis: inpatient Yes · outpatient Yes

Clinical InformationClinical

  • Migraine Disorders

    a class of disabling primary headache disorders, characterized by recurrent unilateral pulsatile headaches. the two major subtypes are common migraine (without aura) and classic migraine (with aura or neurological symptoms). (international classification of headache disorders, 2nd ed. cephalalgia 2004: suppl 1)

Patient EducationClinical

Migraine

Migraines are a recurring type of headache. They cause moderate to severe pain that is throbbing or pulsing. The pain is often on one side of your head. You may also have other symptoms, such as nausea and weakness. You may be sensitive to light and sound.

The full article covers:

  • What are migraines?
  • What causes migraines?
  • Who is at risk for migraines?
  • What are the symptoms of migraines?
  • How are migraines diagnosed?
  • How are migraines treated?

Read the full article at MedlinePlus

Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.

Code History & ChangesHistory

Replacement G43.E11 replaces the following previously assigned code(s):

  • G43.811 - Other migraine, intractable, with status migrainosus
FY 2024AddedAdded to the ICD-10-CM code setEffective October 1, 2023.
FY 2025–2026No changes
FY 2027CurrentCurrent code set, no changesEffective October 1, 2026 through September 30, 2027.

Questions About G43.E11Overview

What is the ICD-10 code for chronic migraine with aura, intractable, with status migrainosus?

The ICD-10-CM code for chronic migraine with aura, intractable, with status migrainosus is G43.E11 (sometimes written as G43E11). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

Is G43.E11 (Chronic migraine with aura, intractable) a billable code?

Yes. This is a billable ICD-10-CM code, specific enough to report chronic migraine with aura, intractable, with status migrainosus on HIPAA-covered claims from October 1, 2026 through September 30, 2027.

What MS-DRG does G43.E11 group to?

When chronic migraine with aura, intractable, with status migrainosus is the principal diagnosis on an inpatient stay, it groups to MS-DRG 102, 103, with relative weights from 0.8219 to 1.1200 depending on complications. Higher weights mean higher Medicare reimbursement.

Can G43.E11 be reported with a code from G43.1?

Not as a rule. The Excludes1 note at G43.E, which applies to G43.E11, lists "migraine with aura (G43.1-)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).

Does G43.E11 need an additional code?

When the condition applies, yes. The Use Additional Code note at G43, which applies to G43.E11, reads: code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5). The additional code is reported after G43.E11.

Does G43.E11 risk-adjust for Medicare Advantage payment?

Not for Medicare Advantage: G43.E11 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 166 (Migraine Headaches).