The substance of this revision for neurology is a repositioning: dementia moves from a special category into the mainstream of primary care.
The dementia-specific community comprehensive care fee and add-on were merged into the general versions, retained as a category for dementia patients. At the same time, the specialist hub role — the remote coordination fee, where a specialist works jointly with a community primary care physician — was substantially expanded.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Dementia community comprehensive care fee and add-on merged | Merged into the general community comprehensive care fee and add-on (retained as a dementia patient category), unified under the primary care function framework | Fee (dementia patients) 1,681 → 1,682 pts; add-ons 38/31 pts unchanged (verify) | Medium |
| Remote coordination fee substantially expanded (D to P with D) | Scope extended beyond designated intractable diseases and epilepsy to children and adults with medical care needs. Previously outpatient only; now billable for home visits and inpatient care. Points unified | Diagnostic 750 pts / other 500 pts → flat 900 pts (once per 3 months) (verify) | Medium |
| Dementia care add-on (inpatient) revised | All tiers increased. The reduction on days with physical restraint tightened from 100/40 to 100/20 | Tier 1 (within 14 days) 180 → 186 pts; tier 2 112 → 115 pts; tier 3 44 → 47 pts (verify) | Medium |
| Intractable disease outpatient guidance fee | No significant change to points or requirements identified | 270 pts (likely unchanged, verify) | Low |
| Headache care | No headache-specific additions or increases identified | — | Low |
2. What it means for the practice
On the outpatient side, confirming your post-merger filing category is the first priority. With the dementia fee folded into the general framework, billing pathways for patients with both dementia and lifestyle disease need redesigning. Eligible conditions for the community comprehensive care add-on now also include chronic heart failure and CKD, and a single-condition-plus-care-need category was created.
Raising the remote coordination fee to 900 points and widening its scope is a clear tailwind for specialized neurology clinics. Previously 750 points for diagnostic purposes and 500 otherwise, outpatient only; now a flat 900 points, billable for home visits and inpatient care, and extended to children and adults with medical care needs. Billing is limited to once every three months, but the structure turns the specialist hub role — working jointly with community primary care physicians on intractable disease and epilepsy — directly into revenue. Building a coordination network with university hospitals and intractable disease centres is a differentiator.
On the hospital side, the increase to the dementia care add-on comes paired with a tightened restraint reduction — from 100/40 to 100/20, meaning 20% billing on days with physical restraint. Operating a restraint-minimization committee and documented alternative care procedures is revenue defense.
3. Practical checklist
- Have you confirmed your filing category after the merger?
- Have you redesigned billing pathways for patients with both dementia and lifestyle disease?
- Have you established partners (university hospitals, intractable disease centres) and a workflow for the remote coordination fee?
- Can you bill the remote coordination fee for home visits and inpatient care?
- (Hospital) Can you track restraint days and document alternative care procedures?
4. Where an AI-native EMR fits — feature by feature
In 2026 this specialty is evaluated less on care completed in-house and more on how well it coordinates within the community. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: External integration and APIs — make the remote coordination fee workable
An OAuth2 gateway, MCP server, and HAPI FHIR support allow integration with external systems.
The remote coordination fee only exists if patient information can move between primary care physician and specialist. The increase to 900 points and the extension to home visits and inpatient care widen the opportunity, but not if referral letters, images, and test results have to be assembled by hand each time. A standards-based (HL7 FHIR) exchange capability sets the ceiling on how many coordinations you can actually run.
Feature 2: Billing and claims management — resolve the post-merger pathway
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
With the dementia fee folded into the general framework, deciding which category is correct for a given patient became more complex. Combinations of dementia, lifestyle disease, and long-term care status change what can be billed. The once-per-three-months limit on the remote coordination fee is the same kind of problem. Keeping the billing logic in the system is what prevents rejections.
Feature 3: AI assistant — summarize a long course
Diagnostic suggestions and differential diagnosis, plus lab value trend summaries and personalized patient explanations.
Dementia, Parkinson's disease, and intractable diseases follow courses that change slowly over years. In a remote coordination session, that course has to be shared in limited time. Being able to summarize "what changed over the past six months" raises both the quality of the coordination and the quality of the explanation back to the primary care physician.
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, "Revisions to the dementia care add-on" https://daitoku0110.jp/entry/dementia-care-addition-2026
- Daitoku Oka, "Major expansion of the remote coordination fee" https://www.docswell.com/s/daitoku0110/5L3VMG-remote-care-2026
- med-cpa, "Revisions to community comprehensive care add-ons" https://med-cpa.jp/hoshu-14/