G43.C1 Periodic headache syndromes in child or adult, intractable

Billable ICD-10-CM code, FY2026.

Applicable to

• Periodic headache syndromes in child or adult, with refractory migraine

Applies from G43 Migraine

Excludes1 (never code together)

• headache NOS (R51.9)
• lower half migraine (G44.00)

Excludes2 (not included here)

• 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

Risk adjustment (HCC)

• RxHCC V08: HCC 166 — Migraine Headaches

MS-DRG index

Defines the logic of DRG(s) 102-103 in MDC 01.

Approximate ICD-9-CM (GEMs)

• 346.21 Variants of migraine, not elsewhere classified, with intractable migraine, so stated, without mention of status migrainosus (approximate)

Code annotations containing back-references to G43.C1

Back-references to G43

• Type 2 Excludes: G44 Other headache syndromes ("migraines (G43.-)")
• Type 2 Excludes: G44.1 Vascular headache, not elsewhere classified ("migraine (G43.-)")
• Type 2 Excludes: G89 Pain, not elsewhere classified ("migraines (G43.-)")
• Type 2 Excludes: R51 Headache ("migraine and other headache syndromes (G43-G44)")

Diagnosis Index entries for G43.C1

• Headache › periodic syndromes in adults and children › with refractory migraine
• Headache › periodic syndromes in adults and children › intractable

Nearby codes

• G43.B Ophthalmoplegic migraine
• G43.B0 Ophthalmoplegic migraine, not intractable
• G43.B1 Ophthalmoplegic migraine, intractable
• G43.C Periodic headache syndromes in child or adult
• G43.C0 Periodic headache syndromes in child or adult, not intractable
• G43.C1 Periodic headache syndromes in child or adult, intractable (this code)
• G43.D Abdominal migraine
• G43.D0 Abdominal migraine, not intractable
• G43.D1 Abdominal migraine, intractable
• G43.8 Other migraine
• G43.80 Other migraine, not intractable