Key Takeaways
- C101 is billed once a month: 1,230 points for the complex case using an intermittent infusion syringe pump, otherwise 650 points for 27 or fewer prescribed injections a month and 750 points for 28 or more.
- The 580-point introduction addition applies within three months from the month of first guidance, and the 150-point biosimilar introduction addition within three months from the first biosimilar prescription; both require face-to-face care.
- Eligible drugs are those in Appendix Table 9 of the facility standards notice, and some carry conditions such as subcutaneous use only.
- In FY2026, for patients whose main disease is diabetes, the lifestyle disease management fee is barred only when C101 is billed while specified drugs such as insulin or GLP-1 receptor agonists are given.
"Is this insulin patient's self-injection fee the 27-or-fewer tier or the 28-or-more tier?" "How many months can the introduction addition be billed?" "Is it true that it can now be combined with the lifestyle disease management fee from FY2026?" These questions come up every month at clinics treating diabetes, rheumatoid arthritis, or dermatology and allergy patients on biologics. Based on the FY2026 medical fee schedule (Public Notice No. 69), the implementation notice (Hoi-hatsu 0305 No. 6) and the facility standards notice (Public Notice No. 71), this article summarizes the points, requirements, eligible drugs and combination rules for the home self-injection guidance and management fee.
Disclaimer: This article provides general information based on materials published as of October 31, 2026. The official public notices and notifications of the Ministry of Health, Labour and Welfare are authoritative for points, requirements and eligible drugs. Always confirm final billing decisions against the latest original texts and the practice of your regional bureau and review bodies.
Overview of the home self-injection guidance and management fee
The home self-injection guidance and management fee (C101) is a home care guidance and management fee billed when guidance and management on self-injection is provided to non-inpatients who self-inject a drug designated by the Minister (public notice).
Points (FY2026 public notice)
| Category | Points | Via telecommunication (notification required) |
|---|---|---|
| 1 Complex case | 1,230 | 1,070 |
| 2 Other cases (a) 27 or fewer injections a month | 650 | 566 |
| 2 Other cases (b) 28 or more injections a month | 750 | 653 |
Additions
| Addition | Points | Period and frequency |
|---|---|---|
| Introduction addition (Note 2) | 580 | Within three months from the month of first guidance, up to three months |
| Introduction addition (Note 3: change in prescription) | 580 | Once, within one month from the month of guidance |
| Biosimilar introduction addition (Note 4) | 150 | Up to three months from the month of the first biosimilar prescription |
Management via telecommunication (Note 5) is billed by an institution notified as meeting the facility standard (an adequate system for telecommunication care) and following the online care guidelines. The introduction addition and the biosimilar introduction addition can only be billed for face-to-face care (implementation notice).
Basic billing rules
Rules common to home care guidance and management fees
| Item | Handling |
|---|---|
| Frequency | Once a month unless otherwise specified. If guidance is given twice or more within one month, bill at the first |
| Multiple home care managements | Only the main management's points are billed |
| Discharge | Billable on the day of discharge when given at discharge; then guidance in the same month is not billed |
| Medical record | Record the basis for home care, instructions (method, cautions, emergency measures) and key points of guidance |
| Supplies | Disinfectants, cotton, gauze, syringes, needles and similar are provided by the institution and included in the points unless separately evaluated |
| Emergency system | A clinic without beds must always secure emergency admission beds at a partner institution |
Requirements specific to C101 (implementation notice)
| Item | Handling |
|---|---|
| Education before introduction | Billable only after the physician has provided sufficient education through admission or two or more outpatient visits, house calls or home visits (not required for adrenaline) |
| Written material | Prepare a document detailing the guidance and give it to the patient |
| Counting injections for "2" | Based on the total number of injections the physician instructed for the month. Unexpected admissions do not reduce it, but periods known in advance, such as planned admissions, are excluded |
| "1" Complex case | For patients using an intermittent infusion syringe pump, when the pump status and dose are checked and adjusted after examination. Program changes are included |
| Multiple institutions | When two or more institutions manage different diseases, each can bill. They must know each other's prescribed drugs |
Details of the introduction addition
- Billed once a month for three months for a newly introduced patient
- A "change in prescription" means a change in the Appendix Table 9 drug, which allows one more billing
- Switches between an originator biologic and its biosimilar, or from one biosimilar to another with the same originator, do not qualify
- Switching to an Appendix Table 9 drug prescribed within the past year also does not qualify
Biosimilar introduction addition
Billed once a month for three months from the first prescription when the biosimilar is prescribed after explaining its efficacy and safety. "Prescribing a biosimilar" means prescribing by its nonproprietary name (with the "biosimilar 1" designation) or by its brand name with "BS" (implementation notice).
Eligible drugs (Appendix Table 9)
Eligible drugs are those listed in Appendix Table 9 of the facility standards notice. The table as amended by Public Notice No. 71 of 2026 includes, for example (excerpt):
| Area (rough guide) | Examples listed in Appendix Table 9 |
|---|---|
| Diabetes and endocrine | Insulin, GLP-1 receptor agonists, insulin/GLP-1 receptor agonist combinations, glucagon, human growth hormone, somatostatin analogs, teriparatide |
| Hematology | Recombinant coagulation factor VIII and IX, emicizumab, G-CSF |
| Immunology, rheumatology, dermatology | Etanercept, adalimumab, tocilizumab, abatacept, secukinumab, dupilumab |
| Lipids, allergy, headache and others | Evolocumab, alirocumab, omalizumab, mepolizumab, galcanezumab, adrenaline |
The list is long and items are added from time to time. Always check the latest Appendix Table 9 before billing.
Drug-specific conditions (implementation notice)
Some listed drugs have conditions on use or route.
| Drug | Billable when |
|---|---|
| Interferon beta | Used for multiple sclerosis only |
| G-CSF | Used for aplastic anemia or congenital neutropenia only |
| Adrenaline | Auto-injector used as emergency adjunct therapy for patients with a history of, or high risk of, anaphylaxis from insect venom, food or toxins |
| Tocilizumab, abatacept, vedolizumab, mirikizumab, crovalimab | Subcutaneous use only |
| Benralizumab | Eosinophilic granulomatosis with polyangiitis only |
| Hydrocortisone sodium succinate | Intramuscular use for patients with a history of, or high risk of, adrenal crisis |
Interferon alfa and the glycyrrhizin combination product also have conditions on diseases and patients.
Cases that cannot be billed and combination rules
| Case | Handling (public notice and implementation notice) |
|---|---|
| Outpatient chemotherapy fee or addition | Patients billed for these in the same month cannot be billed C101 |
| Injections at outpatient visits | Except emergencies, the technique fee and Appendix Table 9 drug cost for that self-injection cannot be billed. For emergencies, note it in the remarks |
| Injections on home visit days | Injection and infusion costs (including drugs and materials) on days the home visit fee (I)/(II) is billed cannot be billed |
| Specific disease management fee and others | For patients under home care guidance management, the specific disease management fee, pediatric guidance fee, epilepsy guidance fee and pediatric malignancy guidance fee are included in the home care fee |
| Pediatric outpatient fee | Not billed when a home care guidance and management fee is billed |
| Intractable disease outpatient fee | Category "2" can be combined with it |
| Other home care guidance fees | Only the main one within the same institution |
Related additions such as the blood glucose self-monitoring addition
Home care guidance fees are billed by adding Section 1 (management fees) and Section 2 (material additions). Additions often combined with C101 are (FY2026 public notice):
| Code | Addition | Points |
|---|---|---|
| C150 | Blood glucose self-monitoring: 20+ / 30+ / 40+ / 60+ times a month | 350 / 465 / 580 / 830 |
| C150 | Same: 90+ / 120+ times (limited to type 1 or post-pancreatectomy insulin users, pediatric hypoglycemia, gestational diabetes, etc.) | 1,170 / 1,490 |
| C150 | Same: intermittently scanned CGM (patients self-injecting insulin at least once a day) | 1,250 |
| C150 | Blood ketone self-monitoring (type 1 diabetes on SGLT2 inhibitors) | 40 |
| C151 | Injector addition (when an injector is prescribed) | 300 |
| C152 | Intermittent infusion syringe pump: programmable / other | 2,500 / 1,500 |
| C152-2 | Continuous glucose monitor (notification required): up to 2 / 3–4 / 5 or more | 1,320 / 2,640 / 3,300 |
| C153 | Injector needles: type 1 diabetes, hemophilia, etc. when medically necessary / other | 200 / 130 |
The 20–60 times tiers of the glucose self-monitoring addition cover, among others, patients self-injecting insulin or human somatomedin C at least once a day. Check the frequency tier and patient requirements against the prescription.
FY2026 changes
1. Relationship with the lifestyle disease management fee
The proviso in Note 1 of the lifestyle disease management fee (I) and (II) was revised.
| Before | After (from June 2026) | |
|---|---|---|
| Main disease is diabetes | Cannot be billed while C101 is billed | Cannot be billed when specified drugs are given and C101 is billed |
The specified drugs are insulin, GLP-1 receptor agonists, insulin/GLP-1 receptor agonist combinations and tirzepatide (Public Notice No. 71). According to the ministry's revision materials, the aim is to promote self-injection management for coexisting non-diabetes diseases by allowing C101 for drugs other than those indicated for diabetes.
For example, handling changes for a patient whose main disease is diabetes, billed the lifestyle disease management fee, who self-injects a biologic for another disease. When insulin or a GLP-1 receptor agonist is given and C101 is billed, the lifestyle disease management fee still cannot be billed.
2. Telecommunication category of the home care guidance fee
The home care guidance fee provided by nurses and others (B001 13) is now divided into the first session (face-to-face, 170 points) and later sessions (face-to-face 170 points / telecommunication 148 points). The telecommunication category is limited to institutions meeting the facility standard, for patients billed C101 or chronic heart failure patients within one month of discharge. Later sessions are once a month (twice in total in the month the first session is billed).
Pre-billing checklist
- Is the prescribed drug in Appendix Table 9, and are drug-specific conditions (such as subcutaneous use only) met?
- Was sufficient education provided through admission or two or more visits before introduction, and is it recorded?
- Was a document describing the guidance given to the patient?
- Does the chart record the basis, instructions (including emergency measures) and key points of guidance?
- Is the 27-or-fewer / 28-or-more tier based on the total injections instructed for the month?
- Is the introduction addition within three months of the first guidance month, and is a prescription change not an excluded type (originator/biosimilar switch, drug used within the past year)?
- Are the introduction additions billed in months with face-to-face care?
- Are the outpatient chemotherapy fee or addition not billed in the same month?
- On days the self-injected drug was given in the clinic, are technique and drug fees not billed (with remarks for emergencies)?
- For diabetic patients on insulin, GLP-1 receptor agonists, etc. with C101, is the lifestyle disease management fee not billed?
- Do the glucose self-monitoring tier and patient requirements match?
FAQ
Q. How many points is the fee? A. Under the FY2026 public notice, 1,230 points for the complex case, otherwise 650 points for 27 or fewer injections a month and 750 for 28 or more. With telecommunication at a notified institution, 1,070, 566 or 653 points instead.
Q. Is the tier based on injections actually given? A. It is based on the total injections the physician instructed for the month at home. Unexpected admissions do not reduce it, but periods known in advance, such as planned admissions, are excluded.
Q. How often can the introduction addition be billed? A. 580 points once a month within three months of the first guidance month. One more billing is allowed when the Appendix Table 9 drug changes, excluding originator/biosimilar switches and switches to drugs prescribed within the past year.
Q. Can the lifestyle disease management fee be billed for insulin patients? A. Not when diabetes is the main disease and insulin, GLP-1 receptor agonists, their combinations or tirzepatide are given with C101 billed. The FY2026 relaxation applies to C101 for other drugs.
Q. Can injection fees be billed when the self-injected drug is given in the clinic? A. Except for emergency visits, the technique fee and the Appendix Table 9 drug cost cannot be billed. For emergency visits, note the emergency in the remarks.
Q. What if the patient also receives self-injection management at another clinic? A. When each institution manages a different disease, both can bill, and each must know the drugs prescribed by the other.
Summary
- C101 is billed once a month: 1,230 points for the complex case; otherwise 650 points for 27 or fewer instructed injections a month and 750 for 28 or more
- The 580-point introduction addition (within three months of first guidance) and 150-point biosimilar introduction addition (within three months of first prescription) require face-to-face care
- Eligible drugs are in Appendix Table 9, with drug-specific conditions in the implementation notice
- Many combinations are barred, such as the outpatient chemotherapy fee in the same month and injection fees at outpatient visits
- From FY2026, for diabetic patients, C101 for drugs other than insulin, GLP-1 receptor agonists and similar can be combined with the lifestyle disease management fee
For the overall billing flow for diabetes, see Diabetes Billing Workflow; for choosing between lifestyle disease management fees, see Lifestyle Disease Management Fee I vs II; for management fees that cannot be combined with home care fees, see Specific Disease Management Fee. For billing checks in internal medicine clinics, see Internal Medicine Clinic EMR and AI Billing Check, and for the full FY2026 revision, see Medical Fee Revision 2026.
Pottech provides AI electronic medical records and billing check functions for clinics that reflect billing requirements. If you have questions about injection frequency tiers, introduction addition periods or combination checks for management fees, please feel free to contact us.
Frequently Asked Questions
- Q. How many points is the home self-injection guidance and management fee?
- A. Under the FY2026 notice, 1,230 points for the complex case, and otherwise 650 points for 27 or fewer injections a month and 750 points for 28 or more. A notified institution providing it via telecommunication bills 1,070, 566 or 653 points instead.
- Q. Is the 27-or-fewer threshold based on injections actually given?
- A. It is based on the total number of injections the physician instructed for that month at home. Unexpected admissions do not reduce it, but periods already known to be outside home care, such as planned admissions, are excluded.
- Q. How often can the introduction addition be billed?
- A. Once a month within three months from the month of first guidance for a newly introduced patient, plus one more time when the prescribed drug changes, excluding switches between an originator biologic and its biosimilar and switches to a drug prescribed within the past year.
- Q. Can the lifestyle disease management fee be billed for insulin patients?
- A. When diabetes is the main disease and insulin, GLP-1 receptor agonists, insulin/GLP-1 combinations or tirzepatide are given while C101 is billed, the lifestyle disease management fee cannot be billed.
- Q. Can injection fees be billed when the self-injected drug is given in the clinic?
- A. Except for emergency visits, the injection technique fee and the cost of the Appendix Table 9 drug for that self-injection cannot be billed at outpatient visits. For emergency visits, note the emergency in the claim's remarks.
参考・出典
- 厚生労働省「診療報酬の算定方法の一部を改正する件」（令和8年厚生労働省告示第69号）医科診療報酬点数表（C101 在宅自己注射指導管理料、第2部第2節第1款通則、C150〜C153、B001-3・B001-3-3 生活習慣病管理料の注1、B001 13 在宅療養指導料、B000等の注、第6部通則6） https://www.mhlw.go.jp/content/12400000/001686842.pdf
- 厚生労働省保険局医療課「診療報酬の算定方法の一部改正に伴う実施上の留意事項について」（令和8年3月5日保医発0305第6号）別添1（第2部第2節第1款 在宅療養指導管理料通則、C101 在宅自己注射指導管理料） https://www.mhlw.go.jp/content/12400000/001757385.pdf
- 厚生労働省「特掲診療料の施設基準等の一部を改正する件」（令和8年厚生労働省告示第71号）（生活習慣病管理料の注1に規定する厚生労働大臣が定める薬剤、在宅自己注射指導管理料に規定する注射薬・同注5の施設基準、別表第九） https://www.mhlw.go.jp/content/12400000/001675855.pdf
- 厚生労働省「令和8年度診療報酬改定 7.外来医療の機能分化・強化等」（生活習慣病管理料（Ⅰ）及び（Ⅱ）の見直し、情報通信機器を用いた療養指導の見直し） https://www.mhlw.go.jp/content/12400000/001681336.pdf