Otolaryngology came through this revision with few large specialty-specific items. Revenue improvement rests mainly on capturing the cross-specialty items — the +1 point return visit fee, the inflation add-on, and the wage increase evaluation fee.
The exception is sleep apnea. The CPAP add-on structure moved, and practices with meaningful sleep apnea volume need to respond.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Sleep apnea (CPAP) | Revisions to the home CPAP guidance fee, a new adherence add-on, and added billing requirements for overnight polysomnography | Home CPAP guidance fee 2: 250 → 240 pts; adherence add-on 15 pts (verify) | Medium |
| Sublingual immunotherapy / allergic rhinitis immunotherapy management fee | No significant specialty-specific change identified (280 pts first month / 25 pts thereafter appears to continue). The cross-specialty push toward long-term prescribing affects how sublingual therapy is prescribed | No change identified (verify) | Low |
| ENT procedures (procedure fees, infant add-ons) | No significant specialty-specific change identified (impact is from cross-specialty inflation and wage items) | — (verify) | Low |
| Hearing aid fitting tests | No change identified | — | Low |
2. What it means for the practice
(1) Practices with sleep apnea volume should check CPAP first. The home CPAP guidance fee 2 lost 10 points from the base, with a 15-point adherence add-on created in its place. Meet the adherence requirement — at least 40% of managed months over the past three months with 20+ days of 4+ hours of use — and you reach 255 points, above the pre-revision level; miss it and you sit at 240, a net decrease. Patients averaging under one hour a day in every one of the past three months can no longer be billed at all. See the pulmonology article for detail.
(2) Sublingual immunotherapy remains a stable revenue source. With no rule change, results are decided by patient accumulation and continuation. Staggering cedar and mite initiation across the year, and supporting three to five years of continuation, is what matters.
(3) Capture the cross-specialty items. Otolaryngology sees large seasonal swings and high volume. The +1 return visit fee, the inflation add-on (2 points each on initial and return), and the wage increase evaluation fee (17–23 initial, 4–6 return) add up. Note in particular that the wage increase evaluation fee cannot be billed without filing.
(4) Post for long-term prescriptions and refills. Sublingual immunotherapy pairs well with long-term prescribing; keep the required posting current.
3. Practical checklist
- (With sleep apnea care) Have you checked and filed for the adherence add-on facility criteria?
- (With sleep apnea care) Are your CPAP devices monitoring-capable, with monthly usage aggregation?
- (With sleep apnea care) Can you identify patients averaging under one hour a day for three consecutive months?
- Have you reviewed the added billing requirements for overnight polysomnography?
- Have you filed for the wage increase evaluation fee?
- Do you know your sublingual immunotherapy continuation rates at 1, 2, and 3 years?
4. Where an AI-native EMR fits — feature by feature
In a year without large increases from the rules, capturing the cross-specialty items and holding patients decide results. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: External integration and APIs — ingest CPAP data
An OAuth2 gateway, MCP server, and HAPI FHIR support allow integration with external systems and devices.
The adherence add-on is a requirement you can only assess once device data is ingested and aggregated by month. Forty percent of managed months over the past three — without that number, you cannot tell whether you are eligible to file. For practices where sleep apnea is a core service, device integration became a precondition for billing.
Feature 2: Patient PHR app integration — sustain sublingual therapy and CPAP
Prescription OCR capture, medication reminders, appointment booking, LINE login, and push notifications.
This specialty's main revenue sources — sublingual immunotherapy and CPAP — both depend on the patient continuing. Three to five years for the former, effectively indefinitely for the latter. Dropout means lost revenue and, for CPAP, erosion of the add-on requirement. Adherence reminders and visit prompts reaching patients are the most directly effective feature here.
Feature 3: Management analytics dashboard — read results through seasonal swings
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
Otolaryngology swings heavily with pollen and infection seasons. Since capturing the cross-specialty items is the main source of upside, you need to separate "did volume change" from "did revenue per patient change." Whether the inflation add-on and wage increase evaluation fee are landing is visible in the unit price trend.
Also review what applies to every specialty
For otolaryngology, capturing the cross-specialty items is the main source of upside. See "what applies to every specialty."
Sources (principal)
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Credo Medical, "FY2026 fee revision seminar for otolaryngology" https://www.credo-m.co.jp/seminar/ent/post-24048/
- Credo Medical, "Revisions to the home CPAP guidance fee" https://www.credo-m.co.jp/column/detail/hosyu/25383/
- Credo Medical, "The allergic rhinitis immunotherapy management fee" https://www.credo-m.co.jp/column/detail/hosyu/7222/