"Can our clinic notify for Child and Adolescent Support Guidance Addition 2?" "The Psychological Support Addition now covers more conditions — what work conditions apply to the psychologist?" "How does this relate to the Note 13 reduction?" These are common questions from directors, office managers and billing staff in psychiatry and psychosomatic clinics. Based on the Ministry of Health, Labour and Welfare (MHLW) FY2026 revision materials and notification checklist, this article organizes points, requirements, notification and practical cautions.
Disclaimer: This article is general information based on public materials as of November 5, 2026. The official sources are MHLW notifications and the guidance of your regional Bureau of Health and Welfare. Always confirm the latest original text and your Bureau before notifying or billing.
Where the two additions fit
Both are additions to Outpatient/Home Psychotherapy (I002). In the MHLW notification checklist, the Psychological Support Addition (Note 9) and Child and Adolescent Support Guidance Addition 2 (Note 10) are newly listed notification items effective June 1, 2026.
| Addition | Direction | Main changes |
|---|---|---|
| Child and Adolescent Support Guidance Addition | Securing acceptance capacity | Addition 1 raised; new Addition 2 with relaxed track-record requirement |
| Psychological Support Addition | Clarifying targets and providers | 250 → 280 points; wider target conditions; new psychologist and facility requirements |
Child and Adolescent Support Guidance Addition: Additions 1 and 2
According to MHLW, the requirements and points were revised to further secure capacity for children and adolescents with mental illness.
| Category | Before | After |
|---|---|---|
| 60+ minutes of outpatient/home psychotherapy (within 3 months of first psychiatric visit at the institution) | 1,000 pts | Addition 1: 1,100 / Addition 2: 500 |
| Other, within 2 years of first visit | 450 | Addition 1: 490 |
| Other, within 1 year of first visit | – | Addition 2: 400 |
| Other | 250 | Addition 1: 290 / Addition 2: 100 |
The facility standard for Addition 2 (excerpt) is that the institution has seen an average of 4 or more new patients under age 20 per month over the past 3 months. For the track-record and training requirements of Addition 1, check the original notification and your Bureau's forms.
Practical point: count under-20 first visits monthly
Addition 2 depends on a track record. Start by counting new under-20 patients for the last 3 months from claims or the EMR and check whether the monthly average reaches 4. Follow the notification forms for how a "first visit" is counted.
Psychological Support Addition: points and targets
| Item | Before | After |
|---|---|---|
| Points | 250 (up to twice a month) | 280 (up to twice a month) |
| Period | Up to 2 years from the month of first billing | Same |
| Target patients | Patients with symptoms caused by trauma | Patients with neurotic, stress-related or somatoform disorders who need psychological support |
| Psychologist | A certified public psychologist instructed by the psychiatrist | Instructed by the psychiatrist; works regularly at least 1 day/week at a psychiatric institution, with 22+ scheduled hours per week for 1+ year (work at other psychiatric institutions is combined) |
| Facility standard | – | At least one dedicated full-time designated psychiatrist (Mental Health Designated Physician) in the institution |
The support must be face-to-face for at least 30 minutes. It may also be billed when provided on a different day from the physician's psychotherapy in the same month. The physician must record in the chart why psychological support is needed.
Be able to prove the psychologist's work record
Keep employment contracts and work records that show "at least 1 day per week," "22+ hours per week" and "1+ year." Work at other institutions can be combined, so a per-institution list of hours helps at notification.
Relation to Note 13 (reduction for non-designated physicians)
When psychotherapy is provided by a non-designated physician at an institution without the Note 13 notification, 60% of the points are billed. In that case the Psychological Support Addition (Note 9) cannot be billed separately. Institutions that notified the Child and Adolescent Specialized Management Addition or the Support Guidance Addition (for patients under 20, etc.) are listed under the Note 13 facility standard (1). For the full picture, see FY2026 revision for psychiatry.
Related changes: CBT and the transition period
The same revision created a 330-point category for Cognitive Behavioral Therapy "with psychological support by a certified public psychologist" and added insomnia as a target (8 sessions for insomnia, 16 for others). Its psychologist requirement (regular work, 22+ hours/week for 2+ years, and more) differs from that of the Psychological Support Addition.
The transitional measure that treats clinical psychology technicians as certified public psychologists ends on May 31, 2028 (Reiwa 10). Check qualifications when planning hires.
Pre-billing checklist
- Notification forms for Note 9 and Note 10 (Addition 2) are newly listed; confirm necessity and timing with your Bureau
- Counted new under-20 patients for the past 3 months (Addition 2)
- Can document the psychologist's days, weekly hours and tenure
- A dedicated full-time designated psychiatrist is in place (Psychological Support Addition)
- Face-to-face support of 30+ minutes is delivered and timed
- The reason for support is in the chart
- Target diagnoses (neurotic, stress-related, somatoform) appear on the claim
- Not billing the Psychological Support Addition for patients under the Note 13 reduction
- Updated point masters in the billing system and EMR
FAQ
Q. Can Additions 1 and 2 be billed together? A. MHLW materials present them as separate categories. Check the original notification on whether both can be billed for the same patient.
Q. Is depression covered by the Psychological Support Addition? A. The target in the materials is patients with neurotic, stress-related or somatoform disorders who need psychological support. Check the notification and your Bureau for individual diagnoses.
Q. Must the support be on the same day as the physician's visit? A. The materials state that it can also be billed when provided on a different day in the month the physician provided psychotherapy.
Summary
- Child and Adolescent Support Guidance Addition 1 is raised (1,100 points for 60+ minutes within 3 months of the first visit); Addition 2 is new (500 points)
- Addition 2 requires an average of 4+ new under-20 patients per month over 3 months
- The Psychological Support Addition rises from 250 to 280 points, with wider targets plus psychologist and designated-psychiatrist requirements
- It cannot be billed under the Note 13 reduction
- Confirm details and timing with your regional Bureau
Contact Pottech
Counting under-20 first visits, recording psychologist session times and checking updated point masters depend heavily on how the EMR and billing system are designed. Pottech helps medical institutions organize EMR and billing operations. See also Preventing missed billing of outpatient psychotherapy, Choosing an EMR for psychiatry and FY2026 fee revision overview. Feel free to contact us.
References
- MHLW, FY2026 Medical Fee Revision, "III-5-4 Evaluation of high-quality psychiatric care" https://www.mhlw.go.jp/content/12400000/001706379.pdf
- MHLW Insurance Bureau administrative notice, May 29, 2026 (notification checklist) https://www.mhlw.go.jp/content/12400000/001706142.pdf
- MHLW notice Hoi-hatsu 0529 No. 2, May 29, 2026 https://www.mhlw.go.jp/hourei/doc/tsuchi/T260602S0040.pdf
- MHLW, "FY2026 Medical Fee Revision" https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00074.html