Japan's FY2026 (Reiwa 8) fee schedule revision took effect on 1 June 2026. The technical fee base rose +3.09% (averaged across FY2026 and FY2027) — the first increase above 3% in roughly thirty years.
Reading that headline number as "a large positive revision" would be a mistake. Most of the increase arrives through the wage increase evaluation fee and the outpatient and home care inflation add-on — line items whose use is effectively earmarked. Clinics that do not raise wages see almost none of the benefit, and no clinic can bill any of it without filing.
This report covers what changed for every specialty. Specialty-specific changes are covered in the individual specialty reports.
1. The revision rate — what is actually inside it
| Category | Rate | Notes |
|---|---|---|
| Technical fee base | +3.09% (2-year average) | FY2026 +2.41% / FY2027 +3.77% |
| of which wage increases | +1.70% | FY2026 +1.23% / FY2027 +2.18% |
| of which inflation | +0.76% | FY2026 +0.55% / FY2027 +0.97% |
| of which meals and utilities | +0.09% | Mainly inpatient |
| of which emergency response | +0.44% | Prior inflation response |
| efficiency and rationalization | ▲0.15% | |
| Drug and material prices | ▲0.87% | Drugs ▲0.86%, materials ▲0.01% |
| Net revision rate | +2.22% |
By sector, the ordinary revision portion is +0.28% for medical, +0.31% for dental, and +0.08% for dispensing. In other words, the pure technical fee increase, excluding wage and inflation components, is only 0.28%.
The defining feature of this revision is two-stage implementation: June 2026 and June 2027. In June 2027 the inflation add-on doubles and the wage increase evaluation fee rises again. Funding and wage plans need to be built over two years, not one.
2. Basic consultation fees — only the return visit fee rose
| Item | Old | New (from 1 Jun 2026) | Change |
|---|---|---|---|
| Initial consultation | 291 pts | 291 pts | Unchanged |
| Return visit | 75 pts | 76 pts | +1 |
| Telephone return visit | 75 pts | 76 pts | +1 |
| Outpatient consultation (200+ beds) | 76 pts | 77 pts | +1 |
| Outpatient management add-on | 52 pts | 52 pts | Unchanged |
| Initial consultation via ICT | 253 pts | 253 pts | Unchanged |
| Return visit via ICT | 75 pts | 76 pts | +1 (matches in-person) |
The only increase to the base fees themselves is +1 point on return visits. The real increase in outpatient revenue per visit comes from the two add-ons below.
3. Wage and inflation response — this is where the money is
Outpatient and home care inflation add-on (new)
Created in response to inflation. No filing is required — every insured medical institution adds it to the basic consultation fee automatically.
| Situation | From Jun 2026 | From Jun 2027 |
|---|---|---|
| Initial consultation | 2 pts | 4 pts |
| Return visit | 2 pts | 4 pts |
| Home visit | 3 pts | 6 pts |
No filing does not mean no work: unless the billing system has been updated, it will not be billed. Check June claims for omissions.
Outpatient and home care wage increase evaluation fee (I) — a large increase
| Category | Old (FY2024) | From Jun 2026 | From Jun 2027 |
|---|---|---|---|
| Initial consultation (new filing) | 6 pts | 17 pts | 34 pts |
| Initial consultation (continuing from FY2024–25) | 6 pts | 23 pts | 40 pts |
| Return visit (new filing) | 2 pts | 4 pts | 8 pts |
| Return visit (continuing) | 2 pts | 6 pts | 10 pts |
| Home visit (separate building) | 28 pts | 79 pts | 158 pts |
Key requirement changes:
- Wage target: a +3.2% base pay increase in each of FY2026 and FY2027 (excluding directors and the clinic director themselves). For nursing assistants and administrative staff, the target is +5.7%.
- Expanded scope: from "staff primarily engaged in medical care" to "staff employed at the insured medical institution," which explicitly includes administrative staff. Employed physicians under 40 were also added (founders and directors are excluded).
- Clinics that already filed must file again, resubmitting the wage improvement plan.
- A reduction for clinics that do not raise wages was newly established (examples exist for inpatient basic fees; the scope for clinics without beds requires verification against primary sources).
17–23 points on initial consultations and 4–6 points on return visits are meaningful for an outpatient-centered clinic. Not filing means simply forgoing the money. At the same time, the administrative burden of wage improvement plans and outcome reports rises, so revising the salary structure in coordination with a labor and social security attorney is urgent. Note that the point value differs depending on whether the clinic filed in FY2024.
4. Digital health — My Number card usage became a performance requirement
The medical information acquisition add-on (1 pt initial, 1 pt return) and the digital health infrastructure add-on (8–12 pts initial, six categories) were both abolished. They were merged and restructured into the new electronic clinical information coordination infrastructure add-on.
| Category | Points | Additional requirement |
|---|---|---|
| Initial consultation, tier 1 | 15 pts (monthly) | Both electronic prescribing and the EHR information sharing service (CLINS) |
| Initial consultation, tier 2 | 9 pts (monthly) | Either electronic prescribing or CLINS |
| Initial consultation, tier 3 | 4 pts (monthly) | Baseline requirements only |
| Return visit / outpatient consultation | 2 pts (monthly) | No tiers |
Common facility requirements: electronic claims submission, free itemized statements, online eligibility verification deployed and usable in the consultation room, a My Number health insurance card usage rate of at least 30% (assessed on claims from three months prior), and, for the upper tiers, the ability to send and receive three documents and six information types in HL7 FHIR format.
Three practical points matter:
- There is no automatic migration from the old add-ons. A new filing is required (a 7 May 2026 deadline has been reported; verify against primary sources).
- A 30% My Number card usage rate is now a hard performance requirement. Below 30%, the clinic loses the add-on entirely. Front desk practice and card reader operations translate directly into revenue.
- Without electronic prescribing or CLINS, a clinic is capped at tier 3 (4 pts) — which can be a decrease against the old digital health add-on (8–12 pts).
A remote electronic prescribing add-on (10 pts, monthly) has also been reported as new (verify against primary sources).
5. Lifestyle disease management — same points, different rules
The base points for lifestyle disease management fees (I) and (II) are unchanged (610–760 pts for (I), 333 pts for (II)), but the operating rules changed substantially.
| Change | Detail | Practical impact |
|---|---|---|
| Narrower bundling for (II) | Concurrently billable management fees expanded from 16 to 37 items | More fee-for-service upside; billing system settings must be revisited |
| Stronger testing requirement for (I) | Blood testing at least once every six months is now a billing requirement | An in-clinic recall process for testing intervals is needed |
| Care plan | The patient signature is abolished. Preparation, delivery, explanation and consent remain required | Lower administrative burden; document how consent is recorded |
| New ophthalmology and dental coordination add-ons | 60 pts each, once per year for coordinating care of diabetic patients (verify against primary sources) | Build a referral partner list |
| Outpatient data submission add-on restructured | Reworked into a quality-weighted enhanced management add-on | Clinics filed as of 31 Mar 2026 have transitional treatment |
The six-month blood testing requirement for (I) deserves particular attention: a missed test means the billing requirement simply is not met. In a clinic managing several hundred such patients, tracking every last test date from memory is not realistic.
6. Patient cost-sharing on long-listed drugs effectively doubled
Under the selective treatment framework, patient cost-sharing on long-listed (originator) drugs rose from one quarter to one half of the price gap, effective 1 June 2026.
If an originator costs 100 yen and the generic 60 yen, the special charge rises from 10 yen to 20 yen (excluding tax). The list of covered products was updated on 1 April 2026.
Also newly added to selective treatment: after-hours dispensing at pharmacies where there is no urgency, and myopia-progression-suppressing eye drops such as atropine.
Both in-clinic posting and publication on the clinic's own website are required, with prices shown as tax-inclusive totals. Explaining the increase to patients who prefer originator drugs adds front desk work, so explanatory materials and notices need updating.
7. Implementation schedule and transitional measures
| Date | Event |
|---|---|
| 19 Dec 2025 | Revision rates decided (base +3.09% / drugs and materials ▲0.87%) |
| 5 Mar 2026 | Official notification (MHLW Notification No. 69) and explanatory materials published |
| 1 Apr 2026 | Drug and material prices take effect. Long-listed drug product list updated |
| 1 Jun 2026 | Main fee schedule takes effect. Inflation add-on, new wage evaluation fee values, electronic clinical information coordination add-on, and the 1/2 cost-sharing on long-listed drugs all begin |
| 30 Sep 2026 | Transitional deadline for some facility requirements (verify item by item) |
| 31 May 2027 | Transitional deadline for BCP requirements (verify) |
| 1 Jun 2027 | Second stage: inflation add-on doubles, wage evaluation fee rises again |
8. Where an AI-native EMR fits — feature by feature
Reduced to one sentence, this revision asks: can you show, with data, that you meet the requirement? My Number card usage rate, blood testing intervals, wage improvement results, filing tiers. All of them are painful to assemble after the fact unless the record accumulates naturally during daily practice. Here is how Pottech's AI-native EMR takes on that work, feature by feature.
Feature 1: Billing and claims management — don't miss the newly restructured add-ons
The automatic billing engine checks bundling, mutual exclusions, and frequency limits, and determines whether each add-on can be billed.
This revision interleaves abolished and newly created items. The medical information acquisition add-on and digital health add-on are gone; the electronic clinical information coordination add-on replaces them, monthly, in three tiers. The inflation add-on bills automatically without filing. Leaving these rule changes entirely to the billing system, rather than having billing eligibility determined in the record itself, is what drives claim errors from June onward.
Feature 2: Billing and claims management — manage the six-month testing requirement as a deadline
For lifestyle disease management fee (I), a missed blood test means the billing requirement is not met. Being able to pull "patients whose last blood test was more than five months ago" from order history is revenue protection, directly. The same structure applies to every add-on with a monthly or annual frequency limit.
Feature 3: External integration and APIs — connect to electronic prescribing and CLINS
An OAuth2 gateway, MCP server, and HAPI FHIR support allow integration with external systems.
The upper tiers of the electronic clinical information coordination add-on (15 and 9 pts) require electronic prescribing and the EHR information sharing service (CLINS). Sending and receiving three documents and six information types in HL7 FHIR format is part of the requirement. The gap between tier 3 (4 pts) and tier 1 (15 pts) is precisely the gap between having and not having an integration layer — and it determines whether a clinic can hold the level of the old digital health add-on (8–12 pts).
Feature 4: Patient PHR app integration — making a 30% card usage rate realistic
Prescription OCR capture, medication reminders, appointment booking, LINE login, and push notifications.
Reaching 30% My Number card usage through front desk prompts alone puts a heavy load on reception. A channel that reaches patients before the visit reduces how often the conversation has to happen at the counter at all. When a billing requirement depends on patient behaviour, having a way to reach patients is a precondition for meeting it.
Feature 5: Management analytics dashboard — track add-on capture monthly
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
When meeting requirements determines whether you can bill, management metrics change too. Alongside patient volume, the operative questions become "what share of eligible patients did we actually bill the add-on for?" and "what is our My Number card usage rate?" With the second-stage increase arriving in June 2027, tracking monthly results is also the foundation for a two-year funding and wage plan.
About this report
Point values and requirements in this article are compiled from secondary sources, including MHLW and Chuikyo published materials and commentary from professional firms. Always verify against primary sources — MHLW notifications (Reiwa 8 MHLW Notification No. 69 and others), official notices, and Q&A documents — before making billing or filing decisions.
Sources (principal)
- MHLW, "FY2026 Fee Schedule Revision: Overview" https://www.mhlw.go.jp/content/12400000/001701061.pdf
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- MHLW, "Basic Policy for the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_66904.html
- Kanto-Shinetsu Regional Bureau of Health and Welfare https://kouseikyoku.mhlw.go.jp/kantoshinetsu/iryo_shido/r08kaitei_00001.html
- Japan Medical Association, "Outline of the FY2026 Fee Schedule Revision" https://www.kochi.med.or.jp/upimage/16539985450_2.pdf
- Japan Medical Journal, "Reading the 3.09% increase to the technical fee base" https://www.jmedj.co.jp/blogs/product/product_27830
- Medical Care Support, "FY2026 basic consultation fees and the inflation add-on" https://medicalcare-support.jp/articles/shinryo-hoshu-2026-kihon-shinryoryo
- Medical Care Support, "Electronic clinical information coordination add-on" https://medicalcare-support.jp/articles/electronic-medical-info-coordination
- med-cpa, "The wage increase evaluation fee explained" https://med-cpa.jp/hoshu-2/
- med-cpa, "Revisions to the digital health infrastructure add-on" https://med-cpa.jp/hoshu-15/
- med-cpa, "Revisions to lifestyle disease management fees" https://med-cpa.jp/hoshu-13/
- keiji-navi, "Selective treatment changes in the June 2026 revision" https://keiji-navi.jp/blog/2026-sentei-ryoyo-jikangai-chouki-shusai-kinshi
- Yuyama, "Key points and responses to the FY2026 revision" https://www.yuyama.co.jp/column/medicalrecord/revision-of-medical-fees-2026-2/