For pediatrics, this revision is almost flat on points. Both the pediatric outpatient fee and the pediatric primary care fee are unchanged for initial consultations, with one point added to return visits in line with the general return visit fee. Upside depends on the cross-specialty items — the inflation add-on and the wage increase evaluation fee.
What changed is not the points but what the billing criteria require. Consultation for suspected developmental disorders, referral to specialist services, and appropriate response to parenting anxiety are now explicitly named as primary care functions under the pediatric primary care fee.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Pediatric outpatient fee (B001-2) | Initial consultation unchanged. Bundled return visit points +1 (reflecting the general return visit increase). Exclusions (patients on palivizumab, nirsevimab) continue | Initial: with prescription 604 pts / without 721 pts (unchanged). Return: with prescription 410 → 411; without 528 → 529 (verify) | Low |
| Pediatric primary care fee (B001-2-11) | Initial unchanged, return +1. Billing criteria now explicitly include consultation and specialist referral for suspected developmental disorders, and appropriate response to parenting anxiety. Training in developmental disorders and abuse is positioned as "desirable" | Fee 1: initial 652/769 pts (unchanged), return 458 → 459 / 576 → 577. Fee 2: initial 641/758 pts, return 447 → 448 / 565 → 566 (verify) | Medium |
| Pediatric specific disease counselling fee (B001-4) | The FY2024 structure is retained. No specialty-specific change identified | Physician: first 800 pts, within 1 yr 600/500, within 2 yrs 500/400, within 4 yrs 400, certified psychologist 200 (unchanged, verify) | Low |
| After-hours, holiday, and night coverage | No pediatric-specific change identified. Facility criteria for the primary care fee continue to require after-hours coverage add-on 1/3 (fee 1) or 2/4, or 6+ annual participations in pediatric emergency care (fee 2) | — | Low |
| Developmental disorders | No pediatrics-only new fee identified. New evaluation in the child and adolescent field sits on the psychiatry side (new child and adolescent support guidance add-on 2, requiring a psychiatry designation) | — | Medium |
2. What it means for the practice
Specialty-specific upside is limited, so capturing the cross-specialty items is the practical revenue strategy. Pediatrics turns over return visits quickly and sees high volume, so 2 points of inflation add-on and 4–6 points of wage increase evaluation fee on return visits accumulate meaningfully.
Meanwhile, the pediatric primary care fee now asks whether the consultation function exists in substance. Three things need standardizing as protection against clawback:
- Consent forms and explanatory documents
- Records of consultation and referral for suspected developmental disorders
- Records of after-hours coverage operations
Training in developmental disorders is currently "desirable," but should be read as likely to become mandatory at the next revision. Completing it this term is worth doing.
For clinics wanting to strengthen psychosocial support for under-20s, adding a psychiatry designation and pursuing the new child and adolescent support guidance add-on 2 — the tier with looser volume requirements — is an option. See the psychiatry article for details.
3. Practical checklist
- Have consent forms and explanatory documents been updated to the current requirements?
- Are consultations and referrals for suspected developmental disorders recorded in the chart?
- Are responses to parenting anxiety documented?
- Can you evidence after-hours coverage (add-on tier, participations in pediatric emergency care)?
- Have you planned training in developmental disorders and abuse?
4. Where an AI-native EMR fits — feature by feature
In 2026 this specialty is asked not about points but about whether the primary care function can be evidenced in the record. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Charting and orders — keep the consultation in the record
AI generates SOAP notes from the consultation audio, and set orders enter tests and prescriptions in one action.
Developmental consultations, responses to parenting anxiety, referrals to specialist services — these arise naturally in the flow of a visit and are exactly the exchanges that fail to reach the record. Pediatrics sees high daily volume, leaving little time per encounter for documentation. Generating the note from audio is what keeps a newly codified requirement from becoming "we did it but there's no record."
Feature 2: Patient PHR app integration — hold the connection with parents
Appointment booking, LINE login and push notifications, and medication reminders.
In pediatrics, the continuing relationship with parents is the substance of "primary care." Immunization schedules, infant health check reminders, guidance on when to seek care during outbreak season. Delivering these to parents is the primary care function in practice — and it also helps meet the 30% My Number card usage requirement attached to the electronic clinical information coordination add-on.
Feature 3: Management analytics dashboard — read results through seasonal swings
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
Pediatrics swings heavily with infectious disease 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 correctly is visible in the unit price trend.
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." For a high-volume specialty like pediatrics, capturing these is the main source of upside.
Sources (principal)
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Knowlety, "Pediatric outpatient fee (FY2026 fee table)" https://knowlety.jp/ika/b001-2/
- Knowlety, "Pediatric primary care fee (FY2026 fee table)" https://knowlety.jp/ika/b001-2-11/
- Shirobon, "B001-4 pediatric specific disease counselling fee (FY2026)" https://shirobon.net/medicalfee/latest/ika/r08_ika/r08i_ch2/r08i2_pa1/r08i21_sec1/r08i211_cls1/r08i2111_B001_0_4.html
- m-assets, "Billing strategy for the pediatric primary care fee 2026" https://m-assets.com/lp/clinic/blog/shoni-kakaritsuke-santei-unyo