Follow-up Visit Fee Additions List: FY2026 Points, Outpatient Management Addition Rules and Combination Limits for Clinics

"Which additions can be billed on top of the follow-up visit fee?" "When can't we bill the outpatient management addition?" "Do additions apply to telephone follow-ups?" Medical clerks and office managers ask these questions often. Follow-up visits make up most outpatient claims, so missed or excessive additions directly affect claim reductions, returns and revenue.

This article lists the additions to the follow-up visit fee (A001, Notes 4-20) in the FY2026 (Reiwa 8) medical fee schedule that are relevant to clinics, with points, requirements and combination rules. For the initial consultation side, see the initial consultation fee additions list.

This article is general information based on publicly available documents as of October 21, 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 follow-up visit fee is 76 points (A001). It can be billed for each follow-up visit, even when there are two or more visits on the same day (circular).

The additions appear in Notes 4-20 of the public notice. The ones relevant to clinics are summarized below.

Follow-up visit additions for clinics

Note: Provisions for hospitals with 200 or more beds in Notes 1-3 (such as the 56-point fee for specific settlement rates) are not covered here.

Infant addition and the after-hours, holiday and late-night additions

Infant addition (38 points)

For a follow-up visit of a child under 6, 38 points are added. However, it is not billed when the Note 5 (after-hours, holiday, late-night) or Note 6 (pediatrics special rule) addition is billed, because those have their own points for children under 6.

After-hours, holiday and late-night additions (Note 5)

The circular states that the handling of the after-hours, holiday, late-night, special after-hours and night/early morning additions is the same as for the initial consultation fee. The standard hours, the principle that regular practice during those hours is not treated as after-hours, and the rule that only one of them can be billed are explained in the initial consultation fee additions list.

Pediatrics special rule (Note 6)

For medical institutions that list pediatrics (including pediatric surgery), 135 / 260 / 590 points can be billed for a child under 6 seen at night, on holidays or late at night, even within the displayed consultation hours (Note 6).

Night/early morning addition (50 points)

A clinic can add 50 points for a follow-up visit from 6 p.m. (noon on Saturdays) to 8 a.m. (excluding late night and holidays), on holidays, or late at night, within its own displayed consultation hours (Note 7). The facility standard is the same as Note 9 of the initial consultation fee. It is a separate evaluation from the after-hours addition (outside displayed hours), and only one of them can be billed according to the circular.

Outpatient management addition (52 points)

Among follow-up additions, this one is prone to both omissions and over-billing.

When it can be billed

For outpatients, 52 points are added when planned medical management is provided without chronic pain management, the examinations designated by the notice, rehabilitation (Part 7), psychiatric specialty therapy (Part 8), procedures (Part 9), surgery (Part 10), anesthesia (Part 11) or radiotherapy (Part 12) (Note 8).

Content required by the circular

The circular requires the physician to take a careful history and perform a detailed physical examination (inspection, auscultation, percussion, palpation, etc.), then reconfirm symptoms and explain the condition and precautions. Four example actions are given:

1. Take a history and summarize the patient's complaints
2. Explain the findings and the medical judgment based on them
3. Explain and guide on precautions in light of the course of treatment so far
4. Draw out the patient's latent questions and concerns

Only the items judged necessary for the patient's condition need to be done; not all are required. However, the key points of the history and findings must be recorded in the medical record.

When it cannot be billed

The addition can be billed regardless of the department listed, and also together with the follow-up fee when a home visit fee is billed.

After-hours response system addition (7 / 5 / 4 / 2 points)

A clinic that has notified its system for handling phone inquiries on days off and at night can add the points for its category when it provides a follow-up visit (Note 10). The points from June 2026, the facility standards for types 1-4 and the notification procedure are explained in After-hours response system addition: FY2026 points, facility standards and notification.

The circular states that the addition can be billed even for telephone follow-ups. In addition to building the system, the emergency response arrangements and contact information must be communicated to patients by posting in the clinic, handing out documents, or printing on appointment cards.

Comprehensive care addition and related additions

Notes 12-14 are a series of additions that evaluate continuous care for patients with chronic diseases.

The circular states that these cannot be billed at the first visit or during home visits (including emergency home visits), and that only one of the comprehensive care fee and the comprehensive care addition can be billed. For eligible patients and facility standards, see Comprehensive care addition: FY2026 points, eligible patients and facility standards.

Infection control additions (Notes 15-18)

The outpatient infection control addition (6 points), fever patient response addition (20), cooperation enhancement addition (3), surveillance enhancement addition (1) and antimicrobial appropriate-use system addition (5) are all once a month. The circular states that the handling is the same as for the initial consultation fee, but they cannot be billed on the follow-up fee if, in the same month, the outpatient infection control addition was billed under Note 11 of the initial consultation fee, General Provision 3 of Medical Management, General Provision 5 of Home Care, or I012. Check your billing system settings so that the same addition is not billed twice in a month under different categories. The requirements are in Outpatient infection control addition.

Electronic health information coordination addition (2 points, monthly) and itemized statement issuance addition (1 point)

The electronic health information coordination addition in Note 19 of the follow-up fee is 2 points once a month (15 / 9 / 4 points for the initial consultation fee). The circular describes it as evaluating systems for medical DX, such as e-prescriptions, electronic medical records, the electronic medical record information sharing service and cybersecurity measures, on the basis of being able to use diagnostic and medication information obtained through online eligibility verification in actual care.

An institution that has notified this addition cannot bill the itemized statement issuance addition (Note 11, 1 point). For the notification approach, see Medical DX-related fees in the 2026 revision.

Telephone follow-ups (Note 9)

The follow-up fee can also be billed when a patient or caregiver asks for therapeutic advice by phone and the physician gives instructions (Note 9). Key points from the circular:

• Applies to patients who had their initial consultation at the institution, for requests made after the follow-up stage
• Not billable if conducted on the premise of regular medical management (a transitional measure exists for patients who had received such follow-ups continuously for 3 months or more as of March 31, 2018)
• Only when the patient's condition changed and appropriate instructions were given. Not billable when it is part of a series of acts incidental to a same-day visit, or merely receiving status reports at intervals
• If requested by the caregiver of an infant, the infant addition applies; during after-hours times, the after-hours, holiday, late-night or night/early morning addition applies (not for fax or email follow-ups)
• In telephone follow-ups, the outpatient management addition, comprehensive care and data submission additions, infection control additions, electronic health information coordination addition, etc. (Notes 8, 12, 13, 15-20) are not billable. The after-hours response system addition (Note 10) can be billed
• Medical management fees (Chapter 2, Part 1) are generally not billable, and special fees for appointment-based consultations cannot be charged
• Fax or email follow-ups are limited to patients with hearing impairments, billable only when responded to promptly, with transmission times recorded in the medical record and copies attached

Second-department follow-up fee (Note 3, 39 points)

When a patient, at their own initiative, sees another department at the same institution on the same day for a different condition, 39 points can be billed for one department that is currently providing continuing care. In this case, the additions in Notes 4-8 and 10-20 (infant, after-hours, outpatient management, comprehensive care, infection control, etc.) are not billed (Note 3, circular).

Also, if a patient under continuing care develops another condition and has an initial consultation for it, the follow-up visit fee is billed instead of the initial consultation fee (circular).

In-clinic checklist

• The outpatient management addition is not automatically added on days with procedures, designated examinations or rehabilitation
• On days the outpatient management addition is billed, the key points of the history and findings are recorded in the medical record
• The outpatient management, comprehensive care and similar additions are not billed on telephone follow-ups
• For children under 6, the infant addition does not overlap with after-hours additions
• The billing system is set so that after-hours, holiday, late-night and night/early morning additions are mutually exclusive
• On second-department follow-up days, no additions from Notes 4-8 and 10-20 are added automatically
• Monthly additions (infection control, electronic health information coordination, etc.) do not overlap for the same patient in the same month
• If the electronic health information coordination addition is notified, the itemized statement issuance addition is not billed
• Notifications required for each addition have been accepted by the regional bureau of health and welfare

FAQ

Q. Can the outpatient management addition be billed automatically on days without procedures? A. No. In addition to not performing procedures, the history, physical examination and explanations required by the circular are needed. If only a simple symptom check is done before continued prescribing, only the follow-up fee is billed.

Q. How many minutes of consultation does the outpatient management addition require? A. The notice and circular we checked contain no minute-based requirement. They do require that the key points of the content of care be recorded in the medical record.

Q. Can the comprehensive care addition be billed at the first visit? A. No. The circular states it cannot be billed at the first visit or during home visits (including emergency home visits).

Q. Can the after-hours response system addition be billed for telephone follow-ups? A. Yes. The circular states it can be billed even for telephone follow-ups.

Summary

• The follow-up visit fee is 76 points. Additions are organized in Notes 4-20; for clinics the main ones are infant, after-hours, night/early morning, outpatient management, after-hours response system, comprehensive care, infection control and electronic health information coordination.
• The outpatient management addition (52 points) is for planned medical management with history, physical examination and explanation, without procedures, designated examinations or rehabilitation. It is not billable for telephone, online or second-department follow-ups.
• Second-department follow-ups (39 points) and telephone follow-ups exclude many additions, so beware of errors caused by automatic additions in your billing system.
• Controlling monthly additions so they do not overlap for the same patient in the same month reduces billing errors.

Preventing omissions and over-billing through systems is the shortest path, as shown in the cause-by-cause billing omission checklist. For the overall picture of the FY2026 revision, see also Medical fee revision 2026.

Potech provides AI electronic medical records for clinics, with billing check features. If you would like to discuss verifying automatic additions on follow-up visits or monthly checks of notified additions, please feel free to contact us.

References

• Ministry of Health, Labour and Welfare, "Notice partially amending the calculation method of medical fees" (MHLW Notice No. 69 of 2026), Medical fee schedule Chapter 1, Part 1, Section 2 Follow-up visit fee (A001, Notes 1-20) https://www.mhlw.go.jp/content/12400000/001686842.pdf
• Ministry of Health, Labour and Welfare, Health Insurance Bureau, Medical Economics Division, "Points to note in implementing the partial revision of the medical fee calculation method" (Hoi-hatsu 0305 No. 6, March 5, 2026, as corrected on October 7), Attachment 1, Part 1, Section 2 Follow-up visit fee https://www.mhlw.go.jp/content/12400000/001757385.pdf