For gastroenterology — particularly endoscopy-focused clinics — this revision is a clear headwind.
The short-stay surgery basic fee 1, "other cases" category, was cut by roughly 50%. That category covers procedures mainly performed on an outpatient basis, including day-case colon polypectomy. For clinics billing under it, the effect is about 800 points per case, immediately.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Short-stay surgery basic fee 1 reduced | "Other cases" (procedures mainly performed as outpatient) roughly halved | With anesthesia 1,588 → 795 pts; without 1,359 → 680 pts (verify) | High |
| Inpatient surgery add-on (new) | For procedures with high outpatient rates performed as inpatient cases on medical grounds. Covers K721 endoscopic colon polypectomy / mucosal resection (under 2 cm) and others. Requires an outpatient surgery volume record | K721 (under 2 cm) 366 pts, new (verify) | Medium |
| Short-stay surgery basic fee 3 revised | Facility criteria changed from "not a DPC hospital" to "is a hospital," opening it to DPC hospitals. Covered procedures added and points adjusted | Varies by procedure (verify) | Medium |
| Endoscopy procedures themselves (upper GI, colonoscopy) | No significant point changes identified (largely unchanged) | — (verify) | Low |
2. What it means for the practice
A 50% cut to "other cases" is a direct revenue reduction for clinics that have been billing day-case polypectomy this way. At 500 cases a year, a reduction of roughly 793 points per case with anesthesia amounts to about 4 million yen annually.
Four responses:
(1) Choose the billing method again. Simulate revenue under bundled billing versus fee-for-service, case by case. With the bundle halved, the assumptions that made bundling favorable no longer hold.
(2) Raise precision on fee-for-service items. Pathology, sedation-related costs, and image-enhanced observation are all separately billable. When unit revenue falls, each missed item weighs relatively more.
(3) Cover with volume. Increase endoscopy referrals from screening and health checks and raise cases per slot. In a falling-price environment, slot utilization and cancellation management determine profit.
(4) Check requirements on the hospital side. Partner hospitals performing under-2 cm polypectomy as inpatient cases can bill the new inpatient surgery add-on (366 pts) — but it carries an outpatient surgery volume requirement. Confirm in advance whether they qualify.
3. Practical checklist
- Have you compared bundled versus fee-for-service revenue for cases currently billed under fee 1?
- Have you audited recent claims for missed pathology, sedation, and image-enhanced observation charges?
- Do you know your endoscopy slot utilization and cancellation rates?
- Has the opening of fee 3 to DPC hospitals changed your local competitive landscape?
- Have you reviewed the referral pathway from screening and health checks?
4. Where an AI-native EMR fits — feature by feature
When unit revenue falls, profit is decided by not missing charges and by keeping slots full. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Billing and claims management — close the gaps on fee-for-service items
The automatic billing engine checks bundling, mutual exclusions, and frequency limits, and determines billing eligibility.
With the bundle halved, capturing every separately billable item matters more than it did. Pathology, sedation agents, endoscopic hemostasis — having these surface automatically as billing candidates from the procedure record is unit-price defense. The bundled-versus-fee-for-service comparison is only possible once the billing logic is explicit.
Feature 2: Management analytics dashboard — measure revenue per slot
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
If the strategy is to offset lower unit revenue with volume, the metric to track is not revenue per case but revenue per endoscopy slot. Slot utilization, same-day cancellation rate, and conversion from diagnostic scope to therapeutic polypectomy, tracked monthly, are the basis for investment decisions.
Feature 3: Patient PHR app integration — prevent cancellations and bowel prep dropouts
Appointment booking, LINE login and push notifications, and medication reminders.
Endoscopy requires bowel preparation, which makes same-day cancellation expensive. Reminders and preparation instructions reaching the patient the day before and the day of directly affect cases per slot. With unit revenue down, an empty slot costs more than it used to.
Also review what applies to every specialty
Consultation fees, the inflation add-on, the wage increase evaluation fee, and the electronic clinical information coordination add-on are collected in "what applies to every specialty."
Sources (principal)
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Daitoku Oka, "Four revision points for the short-stay surgery basic fee" https://www.daitoku0110.news/p/short-stay-surgery-fee-revision
- Clinical Support, "A400 short-stay surgery basic fee (FY2026)" https://clinicalsup.jp/jpoc/shinryou.aspx?file=ika_1_2_4/a400.html
- Funai Consulting, "Impact analysis for endoscopy clinics" https://byoin-clinic-keiei.funaisoken.co.jp/internalmedicine-endoscope/blog/