For gynecology, no significant specialty-specific change was identified.
Cervical cancer screening and HPV-related items, menopause care (HRT and menopausal symptom management), and dysmenorrhea and organic disease items all show no identified additions or increases under insurance.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Cervical cancer screening and HPV | No significant specialty-specific change identified. Population screening and HPV-testing-alone protocols are advancing through municipal cancer screening programmes, outside the fee schedule. No significant change identified to insured HPV nucleic acid testing | — (verify) | Low |
| Menopause care (HRT, menopausal symptom management) | No specialty-specific addition or change identified (impact is from cross-specialty items) | — | Low |
| Dysmenorrhea and organic disease | No specialty-specific change identified | — | Low |
2. What it means for the practice
(1) Not missing the cross-specialty items is the entire revenue strategy. For an outpatient-centred single-specialty gynecology clinic, all of this revision's upside comes from cross-specialty items.
- Return visit fee +1
- Outpatient and home inflation add-on (2 pts initial, 2 pts return; doubling in June 2027)
- Wage increase evaluation fee (17–23 pts initial, 4–6 pts return) — filing required
- Electronic clinical information coordination add-on (4–15 pts initial, 2 pts return) — new filing required, 30% My Number card usage
The wage increase evaluation fee and the electronic clinical information coordination add-on in particular pay nothing without a filing. There is no automatic migration from the old digital health add-on, so confirming that filings are complete is the first priority.
(2) HPV-testing-alone screening is an opportunity for non-insurance revenue. Municipalities are adopting HPV-testing-alone protocols. Screening contracts are a revenue source outside the fee schedule, and building the pathway from screening into insured further investigation (colposcopy, biopsy) turns that into continuing care.
(3) Menopause and women's health build revenue per patient through self-pay combinations. With insurance points static in this area, combining with self-pay services including online consultation remains an effective strategy.
3. Practical checklist
- Have you filed for the wage increase evaluation fee? (a new filing is required even if previously filed)
- Have you filed anew for the electronic clinical information coordination add-on? (no automatic migration)
- Is your My Number card usage rate at least 30%, and can you check it?
- Have you confirmed the inflation add-on lands on consultation claims?
- Have you checked the status of municipal HPV-testing-alone screening contracts?
- Is the pathway from screening into colposcopy and biopsy in place?
4. Where an AI-native EMR fits — feature by feature
In a year without upside from the rules, whether you capture the cross-specialty items and how you design screening and self-pay lines decide results. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Billing and claims management — prevent missed cross-specialty items
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
When all upside comes from cross-specialty items, "are we capturing what we're entitled to" is essentially the whole result. The inflation add-on bills automatically without a filing — but only if the billing system is configured. The electronic clinical information coordination add-on is monthly across three tiers, and its replacement of an old add-on makes configuration oversights easy.
Feature 2: Patient PHR app integration — make a 30% card usage rate realistic
Prescription OCR capture, medication reminders, appointment booking, LINE login, and push notifications.
The 30% My Number card usage requirement attached to the electronic clinical information coordination add-on puts a heavy load on reception if pursued through front-desk prompts alone. A channel reaching patients before the visit reduces how often the conversation has to happen at the counter. The effect per patient is larger at lower-volume single-specialty clinics.
Feature 3: Management analytics dashboard — see the insured / screening / self-pay mix
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
Revenue here tends to be a three-layer structure: insured care, screening contracts, and self-pay services. Without separating what is growing and what is flat, you cannot pick the next move. The less you can expect from the insurance side, the more you need evidence for investing in screening and self-pay design.
Also review what applies to every specialty
For gynecology, capturing the cross-specialty items is close to the whole story. See "what applies to every specialty."
Sources (principal)
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- 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
- Tokyo Association of Medical Practitioners, "FY2026 revision: Chuikyo report (excerpt)" https://www.hokeni.org/docs/2026021200012/