For proctology, the procedure fees for hemorrhoid surgery (K743) are unchanged across all tiers — 1,660 points for sclerotherapy, 4,010 for four-step injection (ALTA), 1,390 for ligation and similar, 5,190 and 6,520 for radical surgery, and 11,260 for PPH.
What fell is the bundled rate when the case is run as a short admission.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Hemorrhoid surgery (K743) procedure fees | No point change identified (all tiers unchanged) | 1 sclerotherapy 1,660 pts / 2 four-step injection (ALTA) 4,010 pts / 3 ligation, cautery, thrombectomy 1,390 pts / 4 radical surgery 5,190 and 6,520 pts / PPH 11,260 pts (unchanged, verify) | Low |
| Short-stay surgery basic fee 3, K743 (four-step injection) reduced | Bundled rate for inpatient ALTA reduced | 9,897 pts (reportedly from 10,386; both figures require verification) | High (facilities doing inpatient ALTA) |
| Fee 3 opened to DPC hospitals | DPC hospitals can now bill fee 3, widening competition for short-admission hemorrhoid cases | — (facility criteria change, verify) | Medium |
| Short-stay surgery basic fee 1 "other" halved | Large reduction where day-case ligation or thrombectomy was billed under fee 1 | With anesthesia 1,588 → 795; without 1,359 → 680 (verify) | Medium |
2. What it means for the practice
(1) Recalculate the economics of the inpatient ALTA model. Specialist facilities running ALTA as one-night admissions under fee 3 lose roughly 490 points (about 5,000 yen) per case — about 2.5 million yen a year at 500 cases. The levers are shortening length of stay (compressing drug and test costs absorbed into the bundle) and evaluating whether outpatient ALTA is feasible.
(2) DPC hospitals entering fee 3 may erode the existing division of labour. With the criteria changed to "is a hospital," DPC hospitals can now bill fee 3, and the assumption that hemorrhoid short admissions belong to specialist facilities may not hold. This is a moment to strengthen differentiation messaging on specialist outcomes — recurrence rates, day-case capability, sphincter preservation.
(3) With procedure fees flat, procedure mix determines unit price. The higher the share of radical excision (5,190 and 6,520 points), the easier it is to hold average revenue per case.
(4) If billing day surgery under fee 1, compare against fee-for-service. Ligation and thrombectomy fall in this group.
3. Practical checklist
- Have you recalculated inpatient ALTA economics at the new fee 3 rate (9,897 pts)?
- Have you examined room to shorten length of stay (moving pre-operative testing to outpatient)?
- Have you assessed whether outpatient ALTA is feasible clinically and operationally?
- Have you compared day surgery billed under fee 1 against fee-for-service?
- Do you know whether local DPC hospitals have started short-admission hemorrhoid cases?
- Do you track procedure mix (ALTA / excision / PPH) monthly?
4. Where an AI-native EMR fits — feature by feature
When bundled rates fall and competition widens, procedure mix and length of stay decide results. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Management analytics dashboard — track procedure mix and length of stay
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
With the fee 3 bundle reduced, what remains per case is determined by length of stay and by how tests and drugs are used. Case counts by procedure, average length of stay, and cost per case — being able to separate these is what makes outpatient-shift decisions and length-of-stay improvements measurable.
Feature 2: Billing and claims management — judge which billing method wins
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
With fee 1 "other" halved, whether bundled or fee-for-service is better now varies case by case for day-case ligation and thrombectomy. Without an accurate picture of what is bundled, the comparison cannot be made. The same applies to fee 3, where capturing non-bundled items reliably drives effective revenue per case.
Feature 3: Patient PHR app integration — lower the barrier to seeking care
Appointment booking, LINE login and push notifications, and medication reminders.
Anorectal conditions are an area where patients hesitate to present, and the psychological barrier to a first visit is the bottleneck on new patients. An online booking path, plus post-operative follow-up and medication reminders reaching the patient, give substance to a specialist positioning. As DPC hospitals widen the competitive field, the quality of the patient relationship becomes a differentiator.
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
- Knowlety, "K743 hemorrhoid surgery (FY2026 fee table)" https://knowlety.jp/ika/k743/
- Daitoku Oka, "Four revision points for the short-stay surgery basic fee" https://www.daitoku0110.news/p/short-stay-surgery-fee-revision
- Clinical Support, "A400 short-stay surgery basic fee (FY2026)" https://clinicalsup.jp/jpoc/shinryou.aspx?file=ika_1_2_4/a400.html