The FY2026 revision raised base fees by 3.09% — a relatively large increase by recent standards — with most of it directed at healthcare worker wage increases and inflation. For clinics, the base-up evaluation fee rose from 6 to 17 points at first visit, home and visiting care saw large increases, and a 2-point inflation response evaluation was added to outpatient first and return visits.
These are largely compensation for rising labor and material costs, so the increase does not translate directly into profit.
1. Macro environment — both revenue and costs rise
Across outpatient care, performance evaluation and functional differentiation of primary care roles were strengthened further. The lifestyle disease management fee now requires blood testing at least once every six months, and coordination add-ons with ophthalmology and dentistry were created — restructuring the framework for managing chronic conditions continuously through management fees.
Neurology's core territory — headache, dementia, Parkinson's disease — consists of chronic, long-follow conditions, so it aligns well with this shift toward rewarding continuity. At the same time, comprehensive community care fees strengthened requirements for dementia patients, and a new outpatient data submission add-on (10 points monthly) was created, demanding visibility of data submission and primary care functions.
On healthcare DX, the previous promotion readiness add-on was consolidated into an "electronic clinical information coordination readiness add-on," with cybersecurity measures made mandatory. The enhanced function add-on newly requires a business continuity plan, extending organizational burden to small practices.
In sum, revenue rises through wage and inflation measures while costs — structural requirements, IT investment, personnel — rise alongside. The realistic answer is to pursue insured care efficiency and revenue diversification through self-pay and specialty clinics simultaneously.
2. Characteristics of newly opened clinics
Neurology is an internal medicine specialty and differs fundamentally from neurosurgery in not presupposing surgery. The typical opener is a board-certified neurologist who treated neurological disorders and stroke at a university or core hospital and is shifting toward outpatient chronic care.
Clinics commonly declare multiple specialties — "neurology and internal medicine," "neurology and neurosurgery," "neurology and psychosomatic medicine" — to cast a wide net for common neurological symptoms: headache, memory concerns, dizziness, numbness.
The dominant facility characteristic is the weight of MRI investment (and reading capacity) from day one. Because imaging is central to evaluating headache, dementia, dizziness, and numbness, whether the clinic has in-house MRI substantially determines patient draw, per-visit revenue, and differentiation. In-house MRI typically pairs tens of millions of yen in equipment investment with a contract for remote reading by radiologists.
Alternatively, some models forgo MRI to limit initial investment and partner with nearby imaging facilities or hospitals — the market has split along location, catchment, and financing lines. Some new clinics now foreground same-day MRI as their headline differentiator.
Operationally, neurology's lack of surgery frees physicians from emergency and on-call duty, but long-term follow of neurological disorders (Parkinson's, ALS) and home care carry heavy physical and time burdens. How far the practice takes on rare disease and home care is the pivot point of its business design. Most new clinics divide those heavier roles with hospitals and home-care specialists while maintaining outpatient throughput in high-volume areas.
3. Revenue areas specific to neurology
Headache clinics (anti-CGRP agents for migraine)
The most watched specialty clinic area in recent years. Anti-CGRP agents (Emgality, Ajovy, Aimovig) are insured as migraine preventives for patients with at least four migraine days per month averaged over three or more months prior, and for whom existing oral preventives are ineffective, not tolerated, or unusable.
| Agent | Interval | Approximate cost at 30% coinsurance |
|---|---|---|
| Emgality | 2 doses initially, then monthly | ¥27,099 first / ~¥13,550 thereafter |
| Ajovy | Monthly or quarterly | ~¥12,400 per dose |
| Aimovig | Every 4 weeks | ~¥12,400 per dose |
Because ongoing self-injection management and home self-injection guidance are involved, a specialist headache clinic generates repeat visits and functions as both specialty differentiation and stable recurring revenue.
Memory and dementia clinics
Demand is structurally expanding with ageing. The arrival of anti-amyloid-beta antibodies (lecanemab, donanemab) has clarified the clinic's role: finding early Alzheimer's disease (MCI to mild) and connecting patients to appropriate facilities.
In practice, clinics identify candidates through cognitive assessment (for example MMSE 22+, CDR 0.5–1) and exclusion via head MRI, refer to initial-administration facilities capable of amyloid confirmation (PET or CSF testing) and first dosing, and then take on follow-up dosing from six months onward, once acute adverse event risk declines. Simple blood biomarker screening is moving toward implementation, and the strategic value of clinics serving as the entry point for early screening will grow further.
Parkinson's disease and neurological disorders at home
Parkinson's disease and ALS are long-term and progressive, generating visiting care and home management needs as travel becomes difficult. Designated intractable disease subsidies and multidisciplinary coordination (visiting nursing, rehabilitation, care management) are prerequisites. High-specialty home care has a high barrier to entry and few local providers, so it can differentiate — but the burden is heavy, so outpatient-focused clinics generally divide the role with home-care specialists and hospitals.
Imaging investment and reading
Because nearly all of the above depends on imaging, MRI is neurology's core equipment and revenue engine. Insured head MRI/MRA, dementia analyses such as VSRAD, and carotid ultrasound run daily, combined with radiologist remote reading to assure accuracy and safety. From a payback perspective, pairing utilization with self-pay brain screening is the rational design.
4. Self-pay services
Self-pay in neurology centers on brain screening (nou-dock). For asymptomatic individuals, MRI and MRA are combined with carotid ultrasound, blood pressure, and blood testing as needed, aiming at early detection of unruptured aneurysms, silent infarcts, brain tumors, and arterial stenosis.
Because there are no symptoms and insurance does not apply, patients pay in full and clinics set their own pricing. From the clinic's side, brain screening fills expensive MRI capacity between insured cases and accumulates high-unit self-pay revenue — the key to both equipment payback and revenue diversification. It aligns naturally with add-on visits from headache and memory clinics, and with demand from health-conscious patients and those with family history of stroke.
Secondary self-pay areas include migraine-related options and uninsured prevention and screening menus (lifestyle disease risk assessment, standalone carotid ultrasound screening). In dementia, blood biomarker testing will likely be productized as self-pay screening as it becomes widespread.
Overall, neurology's self-pay offering is built around imaging, prevention, and early detection, and the core of revenue design is whether you can create mutual referral between self-pay screening and insured chronic follow-up. Note that self-pay menus face medical advertising guideline constraints on pricing and claims, so price transparency and accountability are prerequisites.
5. Management implications
First, the FY2026 revision raises revenue through wage and inflation measures while simultaneously raising costs — structural requirements (cybersecurity, BCP, data submission) and personnel. Margin improvement from insured care alone should be assumed limited.
Second, the MRI-centered trinity of imaging, specialty clinics, and self-pay brain screening is the standard winning formula. Maintain outpatient throughput through headache (anti-CGRP), memory (early screening, referral, follow-up), dizziness, and numbness, while filling the same MRI with self-pay screening to recover the investment — balancing unit price and utilization. For new clinics, choosing between in-house MRI and external partnership is the first fork, alongside financing and location.
Third, differentiation from neurosurgery lies in clearly occupying the position of "we don't operate; we manage with pharmacotherapy and long-term follow." Anti-CGRP agents and dementia disease-modifying therapies both require the internal medicine expertise of finding, selecting, and continuously following patients — where neurology's strengths apply most.
6. How an AI EMR addresses these problems — feature by feature
Neurology carries heavy interview volume — headache, dementia, Parkinson's disease — and requires tracking symptom change over time. As data submission and coordination get built into billing requirements, whether your records are structured starts to matter. Here is how Pottech's AI Karte answers that, feature by feature.
Feature 1: Charting and orders — lighten long neurological interviews and findings
AI structures consultation audio into a SOAP note, and web and paper questionnaires are digitized by camera.
Neurological examination has an exceptionally large number of findings to document. Add that headache, dizziness, and numbness depend heavily on interview quality for diagnosis, and detailed history-taking becomes necessary. The structure of "the more carefully you listen, the more you must write" translates directly into physician burden. Capturing headache character, frequency, triggers, and history in structured form through a pre-visit web questionnaire lets the consultation focus on confirmation and depth.
Feature 2: AI assistant — follow symptom scores over time
Summarizes lab and score trends and personalizes patient-facing explanations.
Continuation decisions for anti-CGRP agents depend on how monthly migraine days changed. Dementia follow-up is evaluated through MMSE and CDR trajectories. Parkinson's disease requires tracking motor symptom fluctuation. In each case, how the numbers moved over time matters more than any single value. Structuring headache diaries and cognitive assessments as longitudinal data and summarizing change feeds directly into decision quality within limited consultation time.
Feature 3: Billing and claims — manage eligibility criteria and schedules
An automated calculation engine checks bundling conflicts, exclusions, and frequency limits, and determines eligibility automatically.
Anti-CGRP agents carry eligibility requirements — at least four migraine days per month over three or more months, ineffective or intolerable oral preventives — and each agent has a different interval (monthly, every four weeks, quarterly). Dementia disease-modifying follow-up dosing likewise involves schedule management. Documenting requirement compliance and managing intervals bears on both billing and safety in this area.
Feature 4: Integrations and APIs — consolidate MRI images and remote reading reports
An OAuth2 gateway, MCP server, and HAPI FHIR enable integration with external systems.
In a specialty built around MRI, both the imaging data and the radiologist's remote reading report are generated outside the chart. When those are disconnected, waiting for reads, transcription, and missed confirmations become clinical delays. Integrating image reports with the chart is a prerequisite for any model that markets same-day MRI as its differentiator. The same foundation serves data submission requirements such as the outpatient data submission add-on.
Feature 5: Document generation — sustain the referral round trip
AI drafts referral letters from patient data, output after physician review and correction.
Dementia disease-modifying therapy operates as a round trip: the clinic screens and refers to an initial-administration facility, then resumes follow-up dosing from six months onward. Neurological disorders similarly presuppose role division with hospitals and home-care specialists. The higher the frequency of that round trip, the more referral-writing effort constrains actual coordination volume.
Feature 6: Practice analytics — make MRI utilization the payback metric
Visit volume, revenue per patient, and monthly trends are aggregated and visualized automatically.
In a design built to recover tens of millions of yen in MRI investment, utilization is the only metric that matters. Without visibility into how insured head MRI/MRA and self-pay brain screening fill each time band and where gaps open, you cannot decide whether to expand or reduce screening slots. Viewing insured and self-pay profitability separately is the foundation of investment judgment in this specialty.
Primary sources
- Japan Medical Association, "FY2026 fee revision: base rate set at +3.09%" https://www.med.or.jp/nichiionline/article/012551.html
- MHLW, "About the FY2026 fee schedule revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Yuyama, "Key points and countermeasures for the FY2026 revision" https://www.yuyama.co.jp/column/medicalrecord/revision-of-medical-fees-2026-2/
- Mediva, "FY2026 revision: outpatient functional differentiation and healthcare DX" https://mediva.co.jp/report/revision/19207/
- Tokyo Metropolitan Institute for Geriatrics, "Treatment with lecanemab and donanemab" https://www.tmghig.jp/hospital/department/dementia-center/cat/
- National Center for Geriatrics and Gerontology, "New drugs for Alzheimer's disease" https://www.ncgg.go.jp/ri/labo/14.html
- Japanese Society of Neurology, "Major neurological conditions (MRI)" https://neurology-jp.org/public/disease/mri.html