CPT (Current Procedural Terminology) codes are five-digit numeric codes used to describe medical, surgical, and diagnostic services. They are maintained by the American Medical Association and used by healthcare providers, insurers, and Medicare for billing and reimbursement.

What is the difference between facility and non-facility rates?

Non-facility (office) rates are what Medicare pays when a service is performed in a physician's office. Facility rates are lower because when a service is performed in a hospital or ambulatory surgery center, the facility bills separately for overhead costs like equipment and supplies.

RVU stands for Relative Value Unit. Medicare uses RVUs to measure the value of physician services based on three components: physician work, practice expense, and malpractice cost. Total RVUs are multiplied by the conversion factor ($33.40 in 2026) to calculate the Medicare payment amount.

Is G43.909 a billable ICD-10-CM code?

Yes. G43.909 (Migraine, unspecified, not intractable, without status migrainosus) is a billable/specific ICD-10-CM code and can be reported on a claim when the documentation supports it.

What procedures are commonly billed with G43.909?

Procedures frequently paired with G43.909 include 99214 (Office/outpatient visit, established patient, moderate complexity). The diagnosis must support medical necessity for the service billed.

ICD-10-CM · G00–G99Billable

ICD-10-CM Code G43.909

Migraine, unspecified, not intractable, without status migrainosus

Source: CMS ICD-10-CM FY2026Effective October 1, 2025Reviewed by the D3rx Clinical Billing Team

Diagnosis information

Billable

Yes

Valid for claim submission

Chapter

G00–G99

Diseases of the nervous system

Risk adjustment

None

Not risk-adjustable (V28)

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Procedures commonly billed with G43.909

CPT/HCPCS procedures frequently paired with G43.909 on claims. The diagnosis helps support medical necessity for the service, but documentation, the service performed, and payer/CMS policy all apply — link each line item to the diagnosis that best documents why it was needed.

99214Office/outpatient visit, established patient, moderate complexity

More codes in the G43 category

Other billable ICD-10-CM codes in the same category as G43.909. Coding to the highest specificity the documentation supports is what keeps a claim clean — pick the child code that most precisely matches the diagnosis.

G43.001Migraine without aura, not intractable, with status migrainosus
G43.009Migraine without aura, not intractable, without status migrainosus
G43.011Migraine without aura, intractable, with status migrainosus
G43.019Migraine without aura, intractable, without status migrainosus
G43.101Migraine with aura, not intractable, with status migrainosus
G43.109Migraine with aura, not intractable, without status migrainosus
G43.111Migraine with aura, intractable, with status migrainosus
G43.119Migraine with aura, intractable, without status migrainosus
G43.401Hemiplegic migraine, not intractable, with status migrainosus
G43.409Hemiplegic migraine, not intractable, without status migrainosus
G43.411Hemiplegic migraine, intractable, with status migrainosus
G43.419Hemiplegic migraine, intractable, without status migrainosus

Documentation & coding notes

G43.909 is a billable/specific ICD-10-CM code — it can be reported as a primary or secondary diagnosis when the documentation supports it. Code to the highest level of specificity the record allows.
Always verify the code against the current ICD-10-CM Official Guidelines and the payer's coverage policy before submitting — coverage, medical necessity edits, and sequencing rules vary by payer.

Related G00–G99 codes

G47.33 G30.9

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Medical coding disclaimer

ICD-10-CM codes and descriptions shown are from the CMS FY2026 official code set and HCC mappings from the CMS-HCC V28 model (payment year 2026), shown for educational reference. Official Guidelines, payer coverage, medical-necessity edits, and sequencing rules vary. Always verify with the current ICD-10-CM Official Guidelines and the payer before submitting claims. D3rx is not responsible for coding or billing outcomes.