For rehabilitation, this revision demands structural change. It is also a joint medical and long-term care revision year.
Two keywords: mobilization and outcomes. Operations built on stacking units now lose revenue outright, and in the convalescent setting the outcome index thresholds were raised.
1. What changed
| Item | Change | Old → New | Impact |
|---|---|---|---|
| Reduction for training without mobilization | Bed-side passive training without mobilization billed at 90/100, up to 2 units per day | ▲10% (verify) | High |
| Early rehabilitation add-on | Within 3 days of admission: 25 → 60 pts (+35); days 4+ 25 pts. Index date changed from onset to admission; billing window unified at 14 days. With the 45-point initial add-on, up to 105 pts/unit | 25 → 60 pts (verify) | Medium–High |
| Holiday rehabilitation add-on (new) | Evaluates weekend and holiday rehabilitation for inpatients, for 30 days from the index date | New: 25 pts/unit (verify) | Medium |
| Comprehensive rehabilitation plan evaluation fee step-down | Reduced after one third of the standard billing period (e.g. day 60 for cerebrovascular, day 50 for musculoskeletal) | Fee 1: 300 → 240 pts on subsequent billings; fee 2: 240 → 196 pts (verify) | Medium |
| Rehabilitation plan document | Patient signature field abolished, explanation extended from physicians to multidisciplinary staff (nurses, PT, OT, ST), format simplified | — | Low (efficiency gain) |
| Convalescent rehabilitation ward fees | Fee 1: 2,229 → 2,346 pts (+117); fee 2: 2,166 → 2,274 (+108); fee 3: 1,917 → 2,062 (+145); fee 4: 1,859 → 2,000 (+141). Outcome index threshold raised from 40 to 42 for fee 1, with 32 newly applied to fees 2 and 4. FIM gain now weighted toward toileting and walking / wheelchair use; the exclusion for patients aged 80+ abolished | As listed (verify) | High |
| Convalescent rehabilitation enhanced capacity add-on (new) | Upper evaluation for fee 1. Requires an outcome index of 48+, a record of pre-discharge home visits, and a continence support add-on filing | New: 80 pts/day (verify) | High |
| Nursing and multidisciplinary collaboration add-on (new) / notional units | Evaluates additional therapist staffing in acute wards. Twenty minutes of non-training work counts as one notional unit (not billable; counts only toward the 18-unit cap) | Verify | Medium |
| Long-term care coordination (joint revision) | Continued push on integrated rehabilitation, nutrition, and oral care, and on transferring maintenance-phase rehabilitation to long-term care insurance with shared care plans | — | Medium |
2. What it means for the practice
(1) Restructuring toward mobilizing programmes comes first. Bed-only passive training is billed at 90% and capped at 2 units a day. Take stock of bed-side-only interventions and convert them. Stacking units now translates directly into lost revenue.
(2) Capture the early rehabilitation add-on fully. Days 1–3 at 60 points (up to 105 per unit with the 45-point initial add-on). The index date moving from onset to admission matters too. Whether you can concentrate intensive early input, including weekends, separates gain from loss.
(3) Use the new holiday add-on (25 pts/unit for 30 days). For facilities running seven days a week, it is a clear positive. Consider it alongside staffing.
(4) In the convalescent setting, the increases are the carrot and the index is the stick. Ward fees rose 108–145 points, but the outcome index threshold went from 40 to 42 for fee 1, with 32 newly applied to fees 2 and 4. The enhanced capacity add-on (80 pts/day) further requires an index of 48+, pre-discharge home visits, and a continence support add-on filing. At roughly 290,000 yen per bed per year, it warrants KPI management worked backwards from those three requirements. The FIM weighting shift toward toileting and walking, and the removal of the 80+ exclusion, both bear directly on the index calculation.
(5) The plan fee step-down costs money in long cases. It applies after one third of the standard billing period. Meeting goals within the standard period, supporting discharge, and building a planned pathway into long-term care rehabilitation (day rehabilitation and similar) are the countermeasures.
3. Practical checklist
- Have you taken stock of bed-side training without mobilization and identified what falls under the 90% reduction?
- Have you planned the conversion to mobilizing programmes?
- Is staffing (including weekends) arranged to start rehabilitation on days 1–3?
- Have you built the capability to bill the holiday rehabilitation add-on?
- Do you know your current outcome index against the 42 (fee 1) and 48 (enhanced add-on) thresholds?
- Have you assessed all three enhanced add-on requirements (index 48, pre-discharge home visits, continence support filing)?
- Can your billing system distinguish first from subsequent billings of the plan evaluation fee?
4. Where an AI-native EMR fits — feature by feature
In 2026 this specialty is paid not for how many units were delivered but for how the intervention was made and how far the patient improved. Here is how Pottech's AI-native EMR helps, feature by feature.
Feature 1: Charting and orders — record mobilization and start date
AI generates SOAP notes from the consultation audio, and set orders enter tests and prescriptions in one action.
What separates the points in this revision — whether mobilization occurred, which day of admission it started, whether it fell on a holiday — cannot be proven if it is not in the implementation record. When therapist record formats vary, you cannot even determine what falls under the 90% reduction. Standardizing granularity is unit-price defense here, plainly.
Feature 2: Management analytics dashboard — watch the outcome index daily
Visit volumes, revenue per patient, and monthly trends are aggregated and visualized automatically.
The convalescent outcome index is not a metric you can aggregate at period end and discover you missed. Forty-two for fee 1, 48 for the enhanced add-on. With FIM weighting changed and the 80+ exclusion removed, prior calculation assumptions no longer hold. Continuous visibility into the gap between current and target values decides whether the add-on is earned — at roughly 290,000 yen per bed per year.
Feature 3: External integration and APIs — connect the handoff to long-term care rehabilitation
An OAuth2 gateway, MCP server, and HAPI FHIR support allow integration with external systems.
This is a joint medical and long-term care revision, and transfer of maintenance-phase rehabilitation to long-term care insurance, with shared care plans, was strengthened. Given the plan fee step-down, a pathway that meets goals within the standard period and transfers to day rehabilitation matters commercially too. Rebuilding the plan document by hand at each transfer breaks down as volume grows.
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." Therapists are in scope for the wage increase evaluation fee, so alignment with the wage improvement plan is required.
Sources (principal)
- MHLW, "About the FY2026 Fee Schedule Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- GemMed, "FY2026 report 9: convalescent rehabilitation wards, new add-ons and outcome indices" https://gemmed.ghc-j.com/?p=73028
- GemMed, "FY2026 report 10: integrated rehabilitation, nutrition, and oral care" https://gemmed.ghc-j.com/?p=73044
- Credo Medical, "FY2026: revisions to the comprehensive rehabilitation plan evaluation fee" https://www.credo-m.co.jp/column/detail/hosyu/25659/
- Reha Tool, "FY2026 fee revision: rehabilitation summary" https://reha-tool.jp/articles/r8-kaitei-matome.html
- PT-OT-ST.NET, "FY2026 fee revision information" https://www.pt-ot-st.net/contents4/medical-treatment-reiwa-8/