For neurosurgery, this revision is clearly positive on two fronts: imaging and endovascular treatment.
MRI scans on 3-tesla-or-higher machines gained 100 points — a straightforward increase in a specialty with high head imaging volume. And percutaneous cerebral thrombectomy gained a tier for cases with concurrent carotid stenting.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| MRI imaging (E202), 3T and above increased | Scans on 3T-or-higher machines +100 pts. 1.5T and others unchanged | Shared use 1,620 → 1,720; other 1,600 → 1,700; 1.5T 1,330 (unchanged); other machines 900 (unchanged) (verify) | High (3T facilities) |
| Head MRI add-on | Continues (3T+, requires filing) | 100 pts (unchanged, verify) | Low |
| Percutaneous cerebral thrombectomy (K178-4), new tier | Split from a single category to add "with concurrent carotid stenting" | 33,150 pts (single) → 1 with carotid stenting 47,150 pts / 2 other 33,150 pts (verify) | Medium (endovascular centres) |
| Hyperacute stroke add-on (A205-2) | No significant change identified (unchanged) | 10,800 pts (first day of admission, unchanged, verify) | Low |
| Cerebrovascular rehabilitation fee (H001) | Base unchanged. The restructured early rehabilitation add-on (days 1–3, 60 pts) and the 90% reduction for non-mobilizing rehabilitation hit stroke rehabilitation directly | (I) 245 / (II) 200 / (III) 100 pts (unchanged, verify) | Medium |
| Brain screening (nou dock) | Self-pay, so outside the revision. Only indirect effect via the 3T MRI increase | — | Low |
2. What it means for the practice
(1) Facilities with a 3T scanner should close capture gaps. An extra 100 points per head MRI is a clean increase where outpatient and emergency head imaging volume is high. Shared-use scans bill at 1,720 points, so check your billing category, including whether shared-use arrangements are filed. At 2,000 scans a year, that is 200,000 points — about 2 million yen.
(2) For thrombectomy, documentation precision is revenue. The 47,150-point tier for concurrent carotid stenting is 14,000 points above the base tier. Case registration and procedure documentation translate straight into revenue, since this is fee-for-service outside any bundle.
(3) Acute stroke rehabilitation tilts toward starting within three days. The early rehabilitation add-on was restructured to 60 points for days 1–3 and 25 for days 4–14, with a 90% reduction for non-mobilizing rehabilitation. Introduce start-date management in the stroke unit and wards, tracking days from onset and admission as a KPI.
3. Practical checklist
- Is the 3T MRI billing category (shared use vs other) set correctly?
- Have you filed for the head MRI add-on facility criteria?
- Are thrombectomy cases with concurrent carotid stenting billed under the new tier?
- Is procedure documentation granular enough to distinguish the new tier?
- (Inpatient) Can you manage rehabilitation start dates by days from onset and admission?
- (Inpatient) Is the 90% reduction for non-mobilizing rehabilitation reflected in billing?
4. Where an AI-native EMR fits — feature by feature
In 2026 this specialty has real upside — provided it is recorded and billed correctly. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Billing and claims management — get the increases onto the claim
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
Both the 3T MRI's +100 points and the thrombectomy tier at 47,150 points only become revenue once they reach the claim. Newly subdivided items are particularly risky: claims submitted under the old category still look normal on the surface. Having the billing category derived automatically from the machine used and the concurrent procedure is the precondition for not losing the increase.
Feature 2: Charting and orders — capture procedure and date accurately
AI generates SOAP notes from the consultation audio, and set orders enter tests and prescriptions in one action.
The new thrombectomy tier turns on whether concurrent carotid stenting was performed — a 14,000-point difference. In an acute setting, that documentation is easily deferred. Rehabilitation start dates work the same way, separating 60 points from 25. Acute care carries the heaviest documentation burden and the most revenue riding on it.
Feature 3: AI assistant — speed up judgement with summarized findings
Diagnostic suggestions and differential diagnosis, plus lab value trend summaries and personalized patient explanations.
In hyperacute stroke, time itself determines outcome. Being able to grasp prior imaging, medication history, and comorbidities quickly shortens time to treatment. Generated explanations for patients and families support one of the hardest informed consent settings there is.
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
- Shirobon, "E202 magnetic resonance imaging (FY2026 fee table)" https://shirobon.net/medicalfee/latest/ika/r08_ika/r08i_ch2/r08i2_pa4/r08i24_sec3/r08i243_E202.html
- Knowlety, "K178-4 percutaneous cerebral thrombectomy (FY2026 fee table)" https://knowlety.jp/ika/k178-4/
- Knowlety, "A205-2 hyperacute stroke add-on (FY2026 fee table)" https://knowlety.jp/ika/a205-2/
- PT-OT-ST.NET, "FY2026 fee revision information" https://www.pt-ot-st.net/contents4/medical-treatment-reiwa-8/