For plastic surgery, no specialty-specific increase was identified. Blepharoptosis surgery, skin and subcutaneous tumour excision, and wound repair are all unchanged.
Meanwhile, the cross-specialty halving of the short-stay surgery basic fee 1 "other cases" category hits this specialty directly. With surgical unit prices flat while labour and material costs rise, this should be read as effectively a negative revision.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Blepharoptosis surgery (K219) | No point change identified (all tiers unchanged) | 1 levator advancement 7,200 pts / 2 fascial graft 18,530 pts / 3 other 6,070 pts (unchanged, verify) | Low |
| Skin and subcutaneous tumour excision (K005/K006) | No significant change identified (unchanged) | e.g. K006 (non-exposed areas) 1,280 / 3,230 / 4,160 / 8,320 pts (unchanged) | Low |
| Wound repair (K000) and dermal suture add-on | Unchanged | Dermal suture add-on 460 pts, debridement add-on 100 pts (unchanged) | Low |
| Short-stay surgery basic fee 1 "other" halved | Where local-anesthesia day surgery (superficial tumour excision and similar) was billed under fee 1, about 800 points per case | With anesthesia 1,588 → 795; without 1,359 → 680 (verify) | Medium |
| Surgical care assurance add-on scope | Covered procedures are reportedly centred on GI surgery; plastic surgery's main procedures appear to be outside scope (the covered K-code list requires verification) | — (verify) | Low |
2. What it means for the practice
(1) Revisit the billing method for fee 1. Facilities using fee 1 for blepharoptosis and skin tumour day surgery must compare against fee-for-service. From 1,588 to 795 with anesthesia, 1,359 to 680 without. With the bundle halved, the assumption that fee 1 was favourable no longer holds.
(2) Revenue improvement depends on self-pay pricing. With insurance points flat while costs rise, clinics offering self-pay services realistically need to review those prices — while staying careful about the boundary between insured and self-pay care.
(3) Judge insured surgery on cases per slot. With unit prices static, the room for improvement is in how operating slots are used: cases per slot, setup and turnover time, same-day cancellation rate.
(4) Capture the cross-specialty items. Make sure the inflation add-on and wage increase evaluation fee land on outpatient claims.
3. Practical checklist
- Have you compared bundled versus fee-for-service revenue for day surgery billed under fee 1?
- Have you audited for missed dermal suture and debridement add-ons?
- Do you know cases per operating slot and your same-day cancellation rate?
- Do self-pay prices reflect rising costs?
- Have you confirmed the inflation add-on and wage increase evaluation fee land on outpatient claims?
4. Where an AI-native EMR fits — feature by feature
In a year when points do not move, missed charges and slot usage decide results. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Billing and claims management — close add-on gaps
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
Plastic surgery has a structure where add-ons accumulate on top of the base procedure — dermal suture (460 pts), debridement (100 pts). In a year without increases, missing them weighs relatively more. The bundled-versus-fee-for-service comparison also requires an accurate picture of what is bundled.
Feature 2: Management analytics dashboard — measure revenue per slot
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
With insurance points static, the metric is revenue per operating slot, not revenue per case. The mix of insured and self-pay procedures, slot utilization, and time per procedure, tracked monthly, inform decisions about restructuring slots and revising prices.
Feature 3: Charting and orders — standardize pre- and post-operative records
AI generates SOAP notes from the consultation audio, and set orders enter tests and prescriptions in one action.
Plastic surgery requires time for pre-operative explanation and post-operative follow-up. For functional procedures such as blepharoptosis in particular, documenting the findings that justify insurance coverage is audit defense. Standardized record formats serve both consultation time and accountability.
Also review what applies to every specialty
For plastic surgery, 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
- Knowlety, "K219 blepharoptosis surgery (FY2026 fee table)" https://knowlety.jp/ika/k219/
- Knowlety, "K006 skin and subcutaneous tumour excision, non-exposed areas (FY2026 fee table)" https://knowlety.jp/ika/k006/
- Knowlety, "K000 wound repair (FY2026 fee table)" https://knowlety.jp/ika/k000/
- Daitoku Oka, "Four revision points for the short-stay surgery basic fee" https://www.daitoku0110.news/p/short-stay-surgery-fee-revision