Psychiatry is the specialty most structurally affected by this revision.
Proviso 13 reduces outpatient and home psychotherapy to 60% of standard points for non-designated physicians at institutions that do not meet the facility criteria. For a return visit under 30 minutes, reported levels are 315 points (designated physician), 290 points (non-designated meeting criteria), and 174 points (non-designated not meeting criteria). For clinics staffed mainly by non-designated physicians, this reaches the core of outpatient revenue.
In the child and adolescent field, however, the wind is clearly at your back.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Initial consultation time tiers (I002) | Increase for initial consultations by designated physicians; new 30-to-60-minute tier | 60+ min (designated) 600 → 650 pts. 30–60 min (designated) 550 pts (new). Non-designated 60+ min 550 pts (verify) | High |
| Proviso 13, 60% reduction (new) | Where the proviso 13 facility criteria are not met, non-designated physicians bill at 60%. Criteria: 20+ years in psychiatric care as of 31 May 2026, or administrative service in the past year. Under the reduction, three or more antidepressants or antipsychotics make it unbillable, and the psychological support add-on cannot be billed concurrently | e.g. return under 30 min: 315 / 290 / 174 pts (verify) | High |
| Exclusion notices (two issued) | 1 May 2026: acute hospitals filed for emergency psychiatric care. 29 May 2026: hospitals filed for disability facility inpatient fees, and under-20 patients at institutions filed for the child and adolescent psychiatric specialist management or support guidance add-ons | — | High |
| Child and adolescent support guidance add-on | Tier 1 increased. New tier 2 with eased volume requirements (monthly average of 4+ under-20 initial consultations over the past 3 months) | Tier 1: within 3 months, 60+ min 1,000 → 1,100 pts; within 2 yrs 450 → 490; other 250 → 290. Tier 2 (new): 500/400/100 pts (verify) | High |
| Community-integrated multifunction psychiatry add-on (new) | For small multifunction hospitals with 350 or fewer psychiatric beds and a psychiatric bed ratio of 65%+. Requires average length of stay within 150 days, 60%+ discharge-to-home within 6 months, multidisciplinary staffing | Tier 1: 800 pts, tier 2: 250 pts, tier 3: 50 pts (new, verify) | High (eligible hospitals) |
| Psychological support add-on | Increased, with scope widened from trauma-related symptoms to neurotic, stress-related, and somatoform disorders. Practitioner requirements clarified (certified psychologist working 22+ hours a week for 1+ year at a psychiatry-designated institution) | 250 → 280 pts (up to twice monthly) (verify) | Medium |
| Cognitive behavioural therapy | New 330-point tier where accompanied by psychological support from a certified psychologist. Insomnia added to eligible conditions (8-session limit; 16 for others). Physician 480 pts and physician-nurse joint 350 pts unchanged | 330 pts (new, verify) | Medium |
| Initial psychotherapy via ICT (new) | New remote initial psychotherapy (requires coordination with public health centres, a mental health professional present with the patient) | 60+ min 566 pts; 30–60 min 479 pts (new, verify) | Medium |
| Psychiatric day care | Base points unchanged (small-scale 590 pts, large-scale 700 pts). The 90/100 step-down for long-term use continues from FY2024 | Unchanged (verify) | Low |
| Psychiatric home-visit nursing | No significant change identified on the medical fee table (I012). On the home-visit nursing side, a new enhanced management fee tier 4 | Enhanced tier 4: 9,030 yen for the first day of the month (new, verify) | Medium |
2. What it means for the practice
(1) Audit proviso 13 eligibility first. For every employed physician and the director: designated mental health physician status, years in psychiatric care (20+), and administrative service history (Medical Treatment and Supervision Act examinations, public health centre or child guidance centre appointments). File promptly where eligible; where not, quantify the loss and reconsider how designated physicians are scheduled.
(2) Check the exclusion notices. Two were issued in May 2026. In particular, under-20 patients at institutions filed for the child and adolescent psychiatric specialist management or support guidance add-ons are excluded — so whether you have a child and adolescent service changes the picture.
(3) The barrier to child and adolescent care fell. Tier 2 with eased volume requirements (a monthly average of 4+ under-20 initial consultations over three months) plus the exclusion from the reduction. Tracking under-20 initial consultations and completing child and adolescent psychiatry training is worth doing now.
(4) The scope for certified psychologists widened substantially. Wider eligible conditions for the psychological support add-on and a new 330-point CBT tier. Designing staffing to meet the employment requirement (22+ hours a week for 1+ year at a psychiatry-designated institution) raises outpatient revenue per patient — though under proviso 13 the psychological support add-on cannot be billed concurrently.
(5) Small multifunction psychiatric hospitals with 350 or fewer beds can earn up to 800 points a day from the community-integrated multifunction add-on. Build KPI management around length of stay and discharge-to-home rates.
3. Practical checklist
- Have you audited physician eligibility under proviso 13 (designation, 20 years, administrative service)?
- Have you checked whether the exclusion notices (1 and 29 May 2026) apply?
- Have you calculated the monthly average of under-20 initial consultations against the tier 2 requirement?
- Do your certified psychologists meet the employment requirement (22+ hours a week, 1+ year)?
- Is the widened scope of the psychological support add-on reflected in the billing system?
- Have you identified patients on three or more antidepressants or antipsychotics and planned dose reduction?
4. Where an AI-native EMR fits — feature by feature
In 2026 this specialty is paid according to who saw the patient, for how long, and on what prescription. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Billing and claims management — resolve physician, time, and prescription together
The automatic billing engine checks bundling, mutual exclusions, and frequency limits.
After this revision, billing here is a product of several conditions: is the attending physician designated, does the institution meet proviso 13, which time tier applies, how many psychotropic classes are prescribed, and is the patient covered by an exclusion notice. Running that on human judgement alone is unworkable. Knowing at the moment of prescribing that a combination is unbillable is far more practical than finding out at month end.
Feature 2: Charting and orders — capture time and content reliably
AI generates SOAP notes from the consultation audio, and set orders enter tests and prescriptions in one action.
With a 30-to-60-minute initial tier now in place, the record of consultation time directly determines the fee. Psychotherapy carries a heavy documentation burden, and accurate time and content records are essential for audit readiness. Generating the note from audio lets the clinician stay present in the session — which is worth more here than in most specialties.
Feature 3: Management analytics dashboard — manage the child and adolescent record
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
Tier 2 requires a monthly average of 4+ under-20 initial consultations over the past three months. That is a requirement you cannot know you are meeting unless you track it. Because it also governs exclusion from the reduction, the monthly trend in under-20 initial consultations became one of the most important management metrics in this specialty. The same mechanism quantifies the loss from proviso 13.
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
- Japanese Society of Certified Clinical Psychologists and others, "FY2026 revision: priority areas (mental health care)" https://www.jccpp.or.jp/files/items/468/File/2026revision%20of%20medical%20fees.pdf
- Japanese Society for Child and Adolescent Psychiatry, "Additional exclusions to the psychotherapy reduction for non-designated physicians" https://child-adolesc.jp/notice/
- National Federation of Health Insurance Doctors' Associations, "Request for withdrawal of proviso 13" https://hodanren.doc-net.or.jp/info/declaration/2026-05-25/
- Knowlety, "Outpatient and home psychotherapy (FY2026 fee table)" https://knowlety.jp/ika/i002/