Condition Guide
High Denial Risk · ICD-10: G43
Migraines Insurance Claim Denied?
Migraine treatment claims, especially for CGRP inhibitors (Aimovig, Ajovy, Emgality) and newer acute treatments, frequently require step therapy through older preventive medications and triptans before authorization.
Why Migraines Claims Are Denied
These are the most common denial reasons for Migraines treatment claims.
Appeal Strategies for Migraines
- 1Document adequate trials of ≥2 oral preventive medications (topiramate, amitriptyline, propranolol, valproate)
- 2Provide migraine frequency and severity documentation — a migraine diary with ≥4 migraines/month for episodic, ≥15 days/month for chronic
- 3For CGRP inhibitor denials, cite AHS (American Headache Society) position statements
- 4For Botox (onabotulinumtoxinA), cite FDA approval for chronic migraine and document trial of ≥2 preventive medications
Common Procedures for Migraines
Select a procedure to see specific denial appeal guides.
Insurer-Specific Guides
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