"How many points does the base-up evaluation fee add to a first or follow-up visit?", "What is the difference between (I) and (II)?", "What do we have to submit every year after notification?" More clinics are notifying the fee to fund staff raises, but few have the billing mechanism and the post-notification reporting duties clearly organized.
Based on the original text of the FY2026 fee schedule (public notice), the billing notice and the facility-standard notice, this article explains the points, billing conditions, facility standards, notification and annual reports for the outpatient/home-care base-up evaluation fees (I) and (II) that matter to clinics.
Disclaimer: This article is general information based on publicly available material as of October 28, 2026. The official notices of the Ministry of Health, Labour and Welfare (MHLW) are the authoritative source. For individual wage or social-insurance decisions, consult a labor and social security attorney, a tax accountant, or your regional Bureau of Health and Welfare.
What is the base-up evaluation fee?
The base-up evaluation fees sit in Part 14 ("Others") of the fee schedule and evaluate measures that improve the wages of staff working at the medical institution. Two are relevant to clinics. (The inpatient base-up evaluation fee applies to facilities that bill inpatient basic fees and is not covered here.)
| Category | Role |
|---|---|
| Outpatient/home-care base-up evaluation fee (I) (O001) | The basic fee billed at each first visit, follow-up visit or home visit by a notified institution |
| Outpatient/home-care base-up evaluation fee (II) (O002) | Billed on top of (I) when further wage improvement is needed. Categories 1 to 24 |
Target staff are those working at the institution, excluding physicians and dentists aged 40 or older and persons working under outsourcing contracts. Physicians under 40, nurses and medical clerks are included (billing notice O001(1)).
Points (public notice)
Outpatient/home-care base-up evaluation fee (I)
| Category | Points | Note 5 (institutions with continued wage increases) |
|---|---|---|
| 1 First visit | 17 | 23 |
| 2 Follow-up visit, etc. | 4 | 6 |
| 3 Home visit (a) not in the same building as other patients | 79 | 107 |
| 3 Home visit (b) other | 19 | 26 |
Under Notes 6 and 7, points increase from June 2027. The base points for 1 to 3 become 200/100 (double), and the Note 5 points become 40 (first visit), 10 (follow-up), and 186 and 45 for home visits (a) and (b).
Outpatient/home-care base-up evaluation fee (II)
(II) has categories 1 to 24, each with points for "first visit or home visit (a)" and "follow-up visit, etc. (b)". The higher the category number, the higher the points.
| Category | (a) First visit / home visit | (b) Follow-up, etc. |
|---|---|---|
| (II) 1 | 8 | 1 |
| (II) 2 | 16 | 2 |
| (II) 3 | 24 | 3 |
| (II) 12 | 96 | 12 |
| (II) 13 (from June 2027) | 104 | 13 |
| (II) 24 (from June 2027) | 192 | 24 |
Categories 13 to 24 are billed from June 2027 (Note 4). Institutions meeting the Note 5 standard bill different points, for example 16 and 2 for (II) 1 and 160 and 20 for (II) 12. See the original notice for all categories.
When you can bill
For (I), the category depends on the basic fee billed (billing notice O001(2) to (5)).
| (I) category | Main situations |
|---|---|
| 1 First visit | When the initial consultation fee, or the first-visit side of the pediatric outpatient or pediatric primary care fee, is billed |
| 2 Follow-up, etc. | When the follow-up consultation fee, outpatient consultation fee, community comprehensive care fee, outpatient oncology chemotherapy fee, etc. is billed |
| 3 Home visit (a) | Home visit fee (I) for patients not in the same building as other patients, and comprehensive home cancer care (home visits) |
| 3 Home visit (b) | The (b) category of home visit fee (I), and home visit fee (II) |
For (II), (a) is billed when (I) category 1 or 3 is billed, and (b) when (I) category 2 is billed (O002(2)(3)). In short, notifying (I) is the precondition for (II).
For the overall picture of additions to these fees, see our guides to first-visit fee additions and follow-up visit fee additions.
Facility standard: requirements for (I)
Section 105 of the facility-standard notice (Hoi-hatsu 0305-8) sets the following.
- The institution provides outpatient or home medical care
- It has target staff
- Revenue from the fee is used for raising base pay or regular monthly allowances (base-up) of target staff, and the resulting increases in bonuses, overtime pay and statutory welfare costs (employer share)
- It complies with labor laws such as the Labor Standards Act
- It informs target staff of how wages will be improved and of work rules, and answers staff questions clearly, for example in writing
- If it billed in earlier years, it has properly submitted the required wage-improvement result reports for the previous and current years
Points on how wage improvement is judged
- The result is judged by the difference between (a) total base pay, etc. when the March or May 2026 pay structure is applied to the staff working in the current year, and (b) the actual total base pay, etc. of staff working in the current year
- Only when revenue exceeds what was used and further base-up is difficult may wages be improved by other means such as bonuses. The items to be improved must be specified
- Pay items other than those improved with the fee (excluding performance-linked items) must not be lowered
- The portion funded by the "FY2025 support project for medical institutions against wage and price increases" subsidy is not included in these totals or the result
- Revenue from fee billing from June to the following May may be applied to wage improvement from April to the following March
Note 5 requirement (continued wage increases)
The Note 5 points apply to an institution that meets either of the following.
- It had notified outpatient/home-care base-up evaluation fee (I) as of March 31, 2026
- In FY2026 it raised base pay, etc. of target staff (excluding physicians and dentists) by at least the equivalent of 5.5% (8% for nursing assistants and clerical staff) compared with the March 2024 pay structure, or in FY2027 by at least 8.7% (13.7% for nursing assistants and clerical staff)
An institution notifying under the latter route must submit Form 98 in addition to Form 95.
Facility standard: requirements for (II) and choosing the category
The main requirements in Section 106 are as follows.
| Requirement | Content |
|---|---|
| Inpatient scale | Fewer than 30 monthly billings in total of inpatient basic fees, specified inpatient fees and short-stay surgery basic fees (except basic fee 1) |
| Other notifications | (I) is notified and the inpatient base-up evaluation fee is not |
| Revenue estimate | Estimated points under (I) × 10 yen are less than 50% of the wage-improvement base amount |
| Staff | At least two full-time-equivalent target staff (except in designated areas) |
| Revenue mix | Social insurance medical care and similar revenue exceeds 80% of total revenue |
| Wages and notice | Same as (I): revenue goes to base-up, labor laws are followed, staff are informed |
The category is determined using a figure [B] calculated from the wage-improvement base amount, estimated (I) points and estimated (II) billings, then matched to Appendix Table 4. If the number of target staff or the total (I) billings change by 10% or more since notification and recalculation changes the category, notify within that month and bill under the new category from the next month. For FY2026 and FY2027, because the points structure changes, institutions notify at the time of new notification and as of June 1 each year so that they can bill the fee.
Notification and annual reports
| Procedure | Content | Form |
|---|---|---|
| Notifying (I) | To the director of the regional Bureau of Health and Welfare. Add Form 98 when notifying Note 5 under the FY2026/2027 base-up result route | Forms 95, 98 |
| Notifying (II) | To the regional Bureau. Also Form 99 when pooling institutions within a corporation | Forms 96, 99 |
| Wage-improvement result and interim reports | Every August, report last year's result and the current year's interim status | Form 100 Attachment 1 (Attachment 2 when consolidating within a corporation) |
| Special circumstances report | When wages of target staff are lowered to sustain the business and wage improvement is then carried out | Form 94 |
| Record keeping | Keep supporting documents for 3 years after the end of the billing year | - |
According to the Kyushu Bureau of Health and Welfare, for the August 2026 submission the result report covered FY2025 and the interim report covered FY2026, with different forms for each, submitted by attaching Excel files to a prefecture-specific email address. Methods and destinations may differ by bureau, so check your own bureau's page before submitting.
Practical checklist
- Target staff (excluding physicians aged 40 or older and outsourced workers) are separated in the payroll ledger
- The pay items for base-up and the target staff are specified and communicated with the work rules
- Fee revenue and wage-improvement amounts are reconciled monthly or quarterly
- The reference pay structure (March or May 2026) and the exclusion of subsidies are documented
- If (II) is notified, someone is assigned to watch for changes of 10% or more in target staff or (I) billings
- The August report and 3-year record retention are on the calendar
- The master update for the June 2027 point change in your billing system and EMR has been scheduled
FAQ
Q. From when is the notification effective?
A. The acceptance timing and first billing month follow the handling of the regional Bureau of Health and Welfare. Check its page for deadlines and start dates before notifying.
Q. Can we notify (I) alone?
A. Yes. (II) requires (I) as a precondition and needs a separate notification.
Q. Are physicians' wages covered?
A. Physicians and dentists aged 40 or older are excluded from target staff. Physicians under 40 are included.
Q. What if revenue exceeds the wage-improvement amount?
A. Only when further base-up is difficult may wages be improved by other means such as bonuses (the items must be specified). For specifics, check the notices and Q&A documents.
Summary
- Base-up evaluation fee (I): 17 points at first visits, 4 at follow-ups, 79/19 at home visits. Points increase from June 2027
- (II) requires notifying (I) and has categories 1 to 24, with requirements on inpatient scale, revenue estimates, two or more FTE target staff and over 80% social insurance revenue
- Revenue goes to base-up of target staff and related costs. Subsidy-funded portions are not counted as wage improvement
- After notification, annual wage-improvement result and interim reports each August and 3-year record retention are required
- For the FY2026 overall picture, see the FY2026 fee revision guide; for the restructuring of digital-health additions, see medical DX additions; for preventing missed billing, see the missed-billing checklist.
Pottech provides an AI-powered EMR for clinics with billing-requirement checks. If you need help updating fee masters for revisions or checking how these fees are being billed, please feel free to contact us.
References
- MHLW, "Notice partially amending the method of calculating medical fees" (MHLW Public Notice No. 69 of 2026), Medical Fee Schedule O001 and O002 https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Insurance Bureau, Medical Care Division, "Points to note in implementing the partial amendment of the fee calculation method" (Hoi-hatsu 0305-6, March 5, 2026), Attachment 1, Part 14 Others, O001 and O002 https://www.mhlw.go.jp/content/12400000/001757385.pdf
- MHLW Insurance Bureau, Medical Care Division, "Handling of facility standards and notification procedures for specified medical fees" (Hoi-hatsu 0305-8, March 5, 2026, as corrected on 7 October), Sections 105 and 106 https://www.mhlw.go.jp/content/12400000/001757367.pdf
- Kyushu Bureau of Health and Welfare, "Base-up evaluation fee result reports (August 2026 submission)" https://kouseikyoku.mhlw.go.jp/kyushu/iryo_shido/base-up-houkoku.html
- MHLW, "FY2026 fee revision" notices page https://www.mhlw.go.jp/stf/newpage_67729.html