"Can we bill the after-hours addition for a patient who comes during the lunch break?" "Is Saturday afternoon after-hours or night/early morning?" "What if we run late during regular hours?" Medical clerks and office managers often ask these questions. The after-hours, holiday, late-night and night/early morning additions depend not only on the clock but also on your displayed consultation hours and the circumstances of the visit, so misconfiguration leads to over-billing or missed revenue.
This article, based on the FY2026 (Reiwa 8) fee schedule and the implementation circular, covers the points and decision rules for the after-hours, holiday and late-night additions to initial and follow-up visit fees, and how they differ from the night/early morning addition. For the full lists of additions, see the initial visit fee additions and follow-up visit fee additions articles.
This article is general information based on publicly available documents as of October 22, 2026. Always check the latest public notices, circulars and guidance from your regional bureau of health and welfare before billing.
Points (public notice)
Points under A000 Note 7 (initial visit) and A001 Note 5 (follow-up visit):
| Category | Initial | Follow-up | Under 6 (initial) | Under 6 (follow-up) |
|---|---|---|---|---|
| After-hours | 85 | 65 | 200 | 135 |
| Holiday | 250 | 190 | 365 | 260 |
| Late-night | 480 | 420 | 695 | 590 |
- They apply to times outside the displayed consultation hours (excluding late night and holidays), holidays (excluding late night), and late night.
- Children under 6 have their own points, and the infant addition is not billed together with them (Note 6 for initial visits, Note 4 for follow-up visits).
Decision rules (circular)
After-hours addition
- Standard hours: roughly before 8:00 and from 18:00 (on Saturdays, before 8:00 and from noon). A day on which a clinic is closed all day, other than a holiday eligible for the holiday addition, is also included.
- Where the standard is hard to apply (e.g. clinics open in the morning and from 18:00), the time outside the displayed consultation hours is treated as after-hours.
- Not applicable when the clinic routinely sees patients: even in those hours, if the clinic is routinely ready to receive patients and treats them as in regular hours, it is not treated as after-hours.
- Clinics must display their consultation hours in an easily visible place.
- It cannot be billed when consultation starts after hours for the clinic's own convenience (except unavoidable circumstances).
Holiday addition
- Holidays are Sundays and national holidays; January 2-3 and December 29-31 are also treated as holidays.
- Eligible patients: (1) patients of institutions recognized as providing holiday emergency care (regional medical support hospitals, certified emergency hospitals/clinics, institutions in emergency care programs); (2) patients who, for an urgent illness or other unavoidable reason, visit a clinic that is closed on that holiday or outside the hours of a clinic open that holiday.
- Patients who visit during the consultation hours of a clinic that is open on that holiday are not included in (2).
Late-night addition
- Late night is 22:00 to 6:00 in every season.
- It is billed when consultation starts late at night, but not when it starts so for the clinic's convenience (except unavoidable circumstances).
- For clinics that operate at night with hours or staffing overlapping 22:00-6:00, the late-night addition cannot be billed for the overlapping hours.
Combination
The circular states that the after-hours, holiday and late-night additions, the special after-hours rule and the night/early morning addition are mutually exclusive: only one applies. Check that your billing software enforces this. Follow-up visits are treated the same as initial visits (circular).
Difference from the night/early morning addition
The night/early morning addition (50 points for both initial and follow-up visits) is billed by clinics that meet the facility standard (public notice, initial Note 9, follow-up Note 7). Its logic is the opposite of the after-hours addition.
| Item | After-hours / holiday / late-night | Night/early morning |
|---|---|---|
| Time covered | Outside displayed hours (holiday/late night for unavoidable visits) | Night, early morning, holiday, late night within displayed hours |
| Time definition | From 18:00 (Sat: noon) to 8:00, etc. (standard) | 18:00 (Sat: noon) to 8:00 (excluding late night and holidays), holidays, late night |
| Eligible institutions | Hospitals and clinics | Clinics only |
| Facility standard notification | Not required | Required |
| Rationale | Burden of resuming care after closing | Evening/early-morning care by clinics (relieving hospital physicians) |
"Displayed consultation hours" for the night/early morning addition means hours publicly announced to the community during which the clinic can always see patients who come in, or hours of planned home visits. Hours when the physician is absent for school physician or occupational physician duties or community events are excluded. The addition cannot be billed when congestion or the clinic's own circumstances cause consultation to start in the eligible hours (judged by reception time).
Decision steps
- Check the time and day of reception (start of consultation).
- Late night (22:00-6:00)? → Check the clinic's hours do not overlap; late-night addition (unavoidable visit).
- Holiday (Sun, national holiday, Dec 29-Jan 3)? → Check whether the clinic is closed or the visit was outside hours for an unavoidable reason; holiday addition. Within displayed holiday hours, the night/early morning addition applies if notified.
- Outside displayed hours? → Check it is not routine consultation or the clinic's convenience; after-hours addition.
- Within displayed hours but at night/early morning (from 18:00, Sat from noon, before 8:00)? → night/early morning addition if notified.
- For under 6, choose the under-6 points instead of the infant addition.
Telephone follow-ups and urgent procedures
- When a patient or caregiver asks by phone for medical advice during after-hours, holiday, late-night or night/early morning times and instructions are given, the corresponding addition can be billed with the follow-up fee. Follow-ups by fax or e-mail do not qualify (circular).
- The after-hours addition for procedures (Procedures, General Rule 5) applies to urgent procedures that follow an initial/follow-up visit billed with the after-hours additions, and does not apply when the night/early morning addition was billed. It cannot be billed when the procedure becomes after-hours for the institution's or physician's convenience.
In-clinic checklist
- Consultation hours are displayed in an easily visible place
- Daily hours (lunch breaks, morning-only days) are correctly registered in billing software
- After-hours additions are not added automatically for times when the clinic routinely sees patients
- After-hours / holiday / late-night / night-early morning additions are mutually exclusive in the software
- For under 6, the infant addition does not overlap with them
- Dec 29-Jan 3 is treated as holidays
- The night/early morning addition is used only by clinics with the notification
- No additions are billed when delays are caused by congestion or internal circumstances
FAQ
Q. Can we bill the after-hours addition for an urgent patient during the lunch break? A. If the lunch break is outside the displayed consultation hours, it can be after-hours. However, if the clinic routinely sees patients then as in regular hours, it is not treated as after-hours.
Q. Consultation ran into the evening because we were busy during regular hours. Can we bill the night/early morning addition? A. It applies if reception was in an eligible time and within displayed hours. It cannot be billed when congestion or the clinic's circumstances caused consultation to start in the eligible hours.
Q. Can the after-hours and night/early morning additions both be billed? A. No. The circular allows only one.
Q. Does the holiday addition apply to patients who visit during the hours of a clinic that is open on a holiday? A. Per the circular, patients visiting during the displayed hours of a clinic open on that holiday are not covered. The night/early morning addition may apply if notified.
Summary
- The after-hours, holiday and late-night additions are for patients who visit outside displayed hours for unavoidable reasons.
- The night/early morning addition is billed by clinics within displayed hours and requires a facility-standard notification.
- Only one of these five additions can apply. Aligning displayed hours with billing software settings helps prevent claim reductions and returns.
Pottech supports clinics with EMR and billing software operations, including reviewing consultation-hour and addition settings. Please feel free to contact us. See also After-hours response system addition and Claim reductions and re-examination.
References
- MHLW, Public Notice No. 69 of Reiwa 8 (revision of the fee calculation method), Medical Fee Schedule A000 Initial Visit Notes 6-9, A001 Follow-up Visit Notes 4-7. https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Insurance Bureau, Circular on implementation (Hoi-hatsu 0305 No. 6, March 5, Reiwa 8), Attachment 1, Part 1 Section 1 Initial visit (18)-(23), Section 2 Follow-up visit (6), telephone follow-ups, Part 9 Procedures. https://www.mhlw.go.jp/content/12400000/001757385.pdf