"Which additions can be billed on top of the initial consultation fee?" "Can we bill both the after-hours addition and the night/early morning addition?" "Does the infant addition apply to a second department visit?" Medical clerks and administrators ask these questions often.
This article lists the additions to the initial consultation fee (A000, Notes 1-16) in the FY2026 (Reiwa 8) medical fee schedule, focusing on those relevant to clinics, with points, requirements and combination rules.
This article is general information based on publicly available documents as of October 20, 2026. Always check the latest public notices, circulars and guidance from your regional bureau of health and welfare before billing.
Basics and overview of the additions
The initial consultation fee is 291 points. An initial consultation using information and communication devices (which requires notification of facility standards) is 253 points (Note 1).
The additions appear in Notes 6-16 of the public notice. The ones relevant to clinics are summarized below.
Initial consultation additions for clinics
| Addition | Points | Note | Notification | Key point |
|---|---|---|---|---|
| Infant addition (under 6) | 75 | Note 6 | Not required | Not billed when the after-hours, holiday or late-night additions are billed |
| After-hours addition | 85 (200 under 6) | Note 7 | Not required | Outside displayed consultation hours (excluding late night and holidays) |
| Holiday addition | 250 (365 under 6) | Note 7 | Not required | Sundays, public holidays, etc. Patient conditions apply |
| Late-night addition | 480 (695 under 6) | Note 7 | Not required | 10 p.m. to 6 a.m. |
| Pediatrics special rule (night / holiday / late night) | 200 / 365 / 695 | Note 8 | Not required | Under 6. Also applies within displayed consultation hours |
| Night/early morning addition | 50 | Note 9 | Facility standards apply | Clinics only. Within displayed hours in night, early morning, holidays or late night |
| Function strengthening addition | 80 | Note 10 | Notification required | Clinics and hospitals under 200 beds with family-doctor functions |
| Outpatient infection control addition | 6, once a month | Note 11 | Notification required | Clinics only |
| Fever patient response addition | 20, once a month | Note 11 proviso | Included in the above | Requires the outpatient infection control addition |
| Cooperation enhancement addition | 3, once a month | Note 12 | Notification required | Requires the outpatient infection control addition |
| Surveillance enhancement addition | 1, once a month | Note 13 | Notification required | Same |
| Antimicrobial stewardship system addition | 5, once a month | Note 14 | Notification required | Same |
| Referred patient acceptance addition (specified-function hospitals, etc.) | 60 | Note 15 | Not required (referral is the condition) | Initial visit upon referral from a specified-function hospital, etc. |
| Electronic clinical information coordination system addition | 15 / 9 / 4, once a month (Additions 1 / 2 / 3) | Note 16 | Notification required | Cannot be combined with the itemized statement issuance addition for follow-up visits |
Notes 2-4 (such as the 216-point rule for large hospitals without a referral letter or with a specified settlement rate) mainly concern hospitals and are not included above.
Infant addition and after-hours, holiday and late-night additions
Infant addition (75 points)
For an initial visit by a child under 6, 75 points can be added. However, when the after-hours, holiday or late-night addition (Note 7) or the pediatrics special rule (Note 8) is billed, the infant addition is not billed. Separate point values for children under 6 (200 / 365 / 695) are set for those additions.
After-hours, holiday and late-night additions (Note 7)
| Category | Standard | Under 6 |
|---|---|---|
| After-hours | 85 | 200 |
| Holiday | 250 | 365 |
| Late night | 480 | 695 |
Key points from the circular:
- Standard for after-hours: roughly before 8 a.m. and from 6 p.m. (on Saturdays, before 8 a.m. and from noon). Where a clinic's displayed hours differ, hours outside the displayed hours may be used.
- Clinics that are in practice always available: if the clinic maintains readiness and treats patients as it does during regular hours, it is not treated as after-hours.
- Starting care after hours for the facility's own convenience (excluding unavoidable circumstances) cannot be billed as after-hours.
- Holidays: Sundays, national holidays, January 2-3 and December 29-31. The holiday addition applies to patients at emergency medical institutions, or patients who visit a closed facility for unavoidable reasons.
- Late night: 10 p.m. to 6 a.m.
- No combination: the after-hours, holiday, late-night, after-hours special rule and night/early morning additions are mutually exclusive under the circular.
Pediatrics special rule (Note 8)
For facilities that list pediatrics (including pediatric surgery), when a child under 6 is seen at night (roughly before 8 a.m. and from 6 p.m., from noon on Saturdays, excluding late night), on holidays or late at night, 200 / 365 / 695 points can be billed even within the displayed consultation hours. The physician need not be a pediatrician.
Night/early morning addition (50 points)
A clinic can add 50 points for an initial visit between 6 p.m. (noon on Saturdays) and 8 a.m. (excluding late night and holidays), on holidays, or late at night, within its own displayed consultation hours (Note 9).
Points from the circular:
- "Displayed consultation hours" means hours publicized to the community in which the clinic can always see patients who arrive, or hours of scheduled home visits. Time when staff are absent for school physician or occupational physician duties or community events is not included.
- It is judged by the time of reception. It cannot be billed when care starts within the target hours because of crowding or facility convenience (excluding unavoidable circumstances).
- It can be billed together with the initial consultation fee when a home-visit fee (C000) is also billed.
- It is not billed together with contact lens examination fees and similar items.
The circular distinguishes the after-hours addition (readiness to treat after the clinic has closed) from the night/early morning addition (treatment during displayed night and early morning hours).
Function strengthening addition (80 points)
A notified clinic, or a hospital with fewer than 200 licensed beds, can add 80 points when billing the initial consultation fee (Note 10). It cannot be added to the second-department initial consultation fee (Note 5 proviso).
Under the circular, as a facility with family-doctor functions the clinic must be able to do the following, post this in the clinic and on its website, and explain it to patients as needed:
- Grasp other medical institutions the patient visits and prescribed drugs, manage medication and record it
- Refer to specialists and specialist institutions
- Respond to health consultations such as health checkup results
- Respond to consultations on health and welfare services
- Provide information on emergency response, including outside consultation hours
For facility standards and post-revision requirements, see Function Strengthening Addition: FY2026 Facility Standards, Notification and BCP Requirement.
Outpatient infection control addition and four related additions
Notes 11-14 form a series of additions that evaluate clinics' infection control.
| Addition | Points (once a month) | Premise and key point |
|---|---|---|
| Outpatient infection control addition | 6 | Notified by the clinic. Once a month per patient |
| Fever patient response addition | 20 | The outpatient infection control addition is billed, and the patient has fever, respiratory, rash, gastrointestinal, neurological or other symptoms suggesting infection and is seen under appropriate infection control including spatial and temporal separation |
| Cooperation enhancement addition | 3 | The clinic reports infection occurrence and antimicrobial use to a medical institution billing Infection Control Addition 1 |
| Surveillance enhancement addition | 1 | The clinic participates in regional or national surveillance such as JANIS or J-SIPHE |
| Antimicrobial stewardship system addition | 5 | The clinic participates in surveillance that can monitor antimicrobial use, and Access antimicrobials are at least 60% of use or within the top 30% of participating clinics |
For the once-a-month rule, facility standards and notification steps, see Outpatient Infection Control Addition: Points, Facility Standards, Notification and the Fever Patient Response Addition.
Referred patient acceptance addition (60 points)
A clinic, or a hospital with fewer than 200 licensed beds, can add 60 points for an initial visit on referral from a specified-function hospital, a regional medical care support hospital (excluding those with fewer than 200 general beds), a referral-focused hospital (same), or a hospital with 400 or more licensed beds (excluding those with fewer than 200 general beds) (Note 15).
Electronic clinical information coordination system addition (15 / 9 / 4 points, once a month)
In the FY2026 revision, the medical DX promotion system addition and the medical information acquisition addition were reorganized, and the electronic clinical information coordination system addition was placed in Note 16. The points are 15 for Addition 1, 9 for Addition 2 and 4 for Addition 3, billed once a month.
The circular describes it as evaluating systems that can use clinical and medication information obtained through online eligibility verification in actual care, together with e-prescriptions, electronic medical records, the electronic medical record information sharing service and cybersecurity measures. A facility that has notified this addition cannot bill the itemized statement issuance system addition for follow-up visits (Note 16; follow-up fee Note 11).
For the notification process and changes from the old additions, see Medical DX-Related Fees in the 2026 Revision.
When additions cannot (or must not) be billed
How the initial consultation fee itself is handled directly affects additions. Common points of confusion at clinics, from the circular:
| Situation | Handling |
|---|---|
| Another condition arises during ongoing treatment | The initial consultation fee is not billed (billed once at the first initial visit, Note 5) |
| Same-day initial visit to another department for a different condition | Only for the second department: 146 points (127 for information and communication devices). Additions in Notes 6-16 are not billed |
| The patient voluntarily stops care and returns after one month or more | Treated as an initial visit even for the same condition. Not treated as initial when the same disease is clearly presumed, such as a chronic disease |
| A disease is found at a checkup without symptoms and the same physician starts treatment | The initial consultation fee cannot be billed (later treatment is covered by insurance) |
| Treatment under workers' compensation or self-pay, or during hospitalization | The initial consultation fee cannot be billed |
| No sign of disease was found | If the patient complained of abnormalities and sought care, the initial consultation fee can be billed |
The circular gives examples of counting one month: "February 10 to March 9" and "September 15 to October 14."
In-clinic checklist
- Displayed consultation hours (website, in-clinic notice, billing software settings) match actual practice
- Billing software makes the after-hours, holiday, late-night, night and early morning additions mutually exclusive
- For patients under 6, the infant addition does not overlap with after-hours additions
- Second-department visits do not automatically receive Note 6-16 additions
- Once-a-month additions (infection control series, electronic clinical information coordination) do not overlap for the same patient in the same month
- Additions that require notification have been accepted by the regional bureau
- Related additions such as the fever patient response addition are not billed in months when the outpatient infection control addition is not notified
FAQ
Q. Can the after-hours addition and the night/early morning addition both be billed? A. No. The circular says the night/early morning addition is not billed when the after-hours addition is billed. Which applies depends on whether the visit falls within the clinic's displayed hours.
Q. Can a non-pediatric clinic bill 200 points for infant night visits? A. The Note 7 after-hours addition (200 for under 6) is for visits outside displayed hours. The Note 8 special rule is for facilities that list pediatrics.
Q. Can the outpatient infection control addition be billed separately for initial and follow-up visits? A. It is limited to once a month, and cannot be billed again in another category in the same month (see the infection control addition article).
Q. Can the function strengthening addition be billed at follow-up visits? A. The function strengthening addition is an addition to the initial consultation fee. It is separate from the comprehensive community care addition for follow-up visits.
Summary
- The initial consultation fee is 291 points. The additions are in Notes 6-16, mainly the infant, after-hours, night/early morning, function strengthening, infection control series, electronic clinical information coordination and referred patient acceptance additions for clinics.
- The after-hours, holiday, late-night, after-hours special rule and night/early morning additions are mutually exclusive under the circular. For children under 6, also watch for overlap with the infant addition.
- Second-department initial visits (146 points) cannot bill the additions in Notes 6-16.
- Controlling once-a-month additions in your billing software so they do not overlap for the same patient in the same month reduces billing errors.
As explained in the cause-by-cause checklist on missed billing, preventing missed or excess billing through systems is the shortcut. For the whole FY2026 revision, see also Medical Fee Revision 2026.
Pottech provides AI electronic medical records and billing check functions for clinics. If you have questions about preventing missed billing for additions, or monthly checks of notified additions, please feel free to contact us.
References
- MHLW, "Partial Revision of the Fee Schedule for Medical Treatment" (FY2026 MHLW Public Notice No. 69), medical fee schedule, Chapter 1 Part 1 Initial and Follow-up Consultation Fees (A000 Initial Consultation Fee, Notes 1-16) https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Health Insurance Bureau, "Implementation points for the partial revision of the fee schedule" (March 5, 2026, Hoi-hatsu 0305 No. 6, 1007 corrected version), Attachment 1, Part 1 Section 1 Initial Consultation Fee https://www.mhlw.go.jp/content/12400000/001757385.pdf