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ICD-10-CM G43.401: Hemiplegic migraine, not intractable, with status migrainosus

G43.401 is the billable ICD-10-CM code for hemiplegic migraine, not intractable, with status migrainosus, in category G43 (Migraine) of the Episodic and paroxysmal disorders section. As a principal diagnosis it groups to MS-DRG 102 Headaches with MCC, MS-DRG 103 Headaches without MCC (MDC 01 MDC 01: Diseases and Disorders of the Nervous System). 19 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
G43.401
billable FY2027 ICD-10-CM code
Category
G43 Migraine
Chapter
6: Diseases of the nervous system (G00-G99)
CC/MCC (MS-DRG v44)
Neither
CMS-HCC V28
Not mapped
POA reporting
Required

Tabular list notes for G43.401

The tabular list has no notes on G43.401 itself; the notes below apply from its parent headings.

Inherited from G43 (Migraine)

Excludes1 (never coded together)
  • lower half migraine (G44.00)
Excludes2 (not part of this condition, may be coded together)
  • headache NOS (R51.9)
  • headache syndromes (G44.-)
Use additional code
  • code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
Notes
  • the following terms are to be considered equivalent to intractable: pharmacoresistant (pharmacologically resistant), treatment resistant, refractory (medically) and poorly controlled

Inherited from G43.4 (Hemiplegic migraine)

Inclusion terms
  • Familial migraine
  • Sporadic migraine

Inherited from G43.40 (Hemiplegic migraine, not intractable)

Inclusion terms
  • Hemiplegic migraine without refractory migraine

MS-DRG grouping when G43.401 is the principal diagnosis

MS-DRG v44 groups for G43.401 as principal diagnosis
MDCMS-DRGs
01 MDC 01: Diseases and Disorders of the Nervous System102103

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for G43.401 shows the full grouping logic.

CC/MCC status and inpatient edits

G43.401 is neither a CC nor an MCC under MS-DRG v44, so as a secondary diagnosis it does not raise the MS-DRG severity level. Check G43.401 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.

CMS-HCC V28 risk adjustment

G43.401 does not map to a payment HCC in the PY2027 CMS-HCC V28 model, so on its own it does not change a Medicare Advantage risk score.

LCD billing and coding articles that list G43.401

19 current Medicare billing and coding articles list G43.401 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM G43.401 mean?

G43.401 means hemiplegic migraine, not intractable, with status migrainosus. It is one of 25 billable codes under G43, migraine.

Which MS-DRG does G43.401 group to?

As the principal diagnosis, G43.401 groups to MS-DRG 102 Headaches with MCC, MS-DRG 103 Headaches without MCC (MDC 01 MDC 01: Diseases and Disorders of the Nervous System) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.