The locomotor rehabilitation fee (H002) is a pillar of revenue for orthopedic clinics, yet it is an item whose billing rules are complex and error-prone—differences in points by facility standards I–III, unit-count management, the standard number of billing days, and the handling of reductions. This article organizes the billing of the locomotor rehabilitation fee from a practical viewpoint, centering on facility standards and unit counts. Note that specific point values and the latest requirements change with medical fee revisions, so always confirm the latest information in the official sources listed at the end.
What is the locomotor rehabilitation fee?
The locomotor rehabilitation fee is an item that evaluates rehabilitation performed to restore function for diseases of the locomotor organs—upper limbs, lower limbs, trunk, and so on—and their postoperative states and injuries. It is one of the most frequently billed rehabilitation fees in orthopedics, performed individually by PTs (physical therapists), OTs (occupational therapists), and others.
The basic unit of billing is 20 minutes per unit, and units are counted according to time. There is an upper limit on the units billable per day for a single patient, and standard and upper limits are also set on the units performed per staff member. Because the specific unit-count limits and points change with revisions, please confirm them in the sources.
Differences among facility standards I–III
The locomotor rehabilitation fee is divided into classifications (I), (II), and (III) according to facility standards, with (I) being the highest points and (III) the lowest. The classification is determined mainly by requirements such as the assignment of dedicated/exclusive physicians and staff, the area of the training room, and the necessary machinery and equipment.
| Classification | Level of points | Tendency of main requirements |
|---|---|---|
| Locomotor rehab fee (I) | Highest | The most substantial requirements for a dedicated full-time physician, the number of exclusive full-time PTs/OTs, training-room area, etc. |
| Locomotor rehab fee (II) | Middle | Personnel and facility requirements more relaxed than (I) |
| Locomotor rehab fee (III) | Lowest | Can be filed with minimal personnel and facilities |
Which classification your clinic files under is judged by balancing the personnel structure and facility requirements you can secure against the points you can bill. Because the specific numbers and areas of the requirements are revised at each fee revision, always confirm the latest facility-standard notice before filing.
Standard billing days and reductions
For disease-specific rehabilitation, a standard number of billing days is set for each disease. In locomotor rehabilitation, if care continues beyond this standard number of days, the handling changes—for example, the monthly billable unit count may be restricted, or prescribed requirements (such as those regarding the prospect of improvement) may need to be met.
In addition, there is a mechanism whereby points are reduced under certain conditions. Because the start date for counting the standard billing days, the handling after exceeding them, and the conditions for applying reductions are error-prone, per-patient start-date management is important.
Practical points to note
- Management of start date / counting date: Accurately record the counting start date of the standard billing days for each patient
- Management of unit-count limits: Manage so as not to exceed the per-patient and per-staff unit-count limits
- Same-day billing restrictions: Be careful with procedures that cannot be billed on the same day as rehabilitation (bundled into rehabilitation), such as anti-inflammatory pain procedures (see the separate article "Billing easily mistaken in orthopedics")
- Consistency of performance records: Whether the rehabilitation performance records in the chart match the billing content
These tend to cause oversights with manual management alone and become causes of missed billing and audit deductions and returned claims.
Billing-management support with AI Karte
"AI Karte," developed by Pottech, is an integrated rececon type (chart and accounting/billing on the same foundation) equipped with an AI rezept-checking function. For the complex billing of the locomotor rehabilitation fee, it enables the following support.
- Management of unit counts and counting dates: Makes it easier to grasp each patient's unit counts and the counting start date of the standard billing days on the chart
- AI rezept checking: Detects in advance combinations with procedures that cannot be billed on the same day, and missed billing
- Linkage of chart and billing: Rehabilitation performance records are directly reflected in billing, reducing transcription mistakes
- Handling of revisions: The system is updated in line with fee revisions, supporting operation in accordance with the latest rules
In closing
The locomotor rehabilitation fee is an item with many rules to master—the selection of facility standards I–III, the management of unit counts and standard billing days, and the restrictions of reductions and same-day billing. Accurate billing requires a mechanism that reliably manages each patient's counting date and unit counts and checks consistency with the rules at the billing stage. Because the specific values of points, unit counts, and facility standards change with revisions, always refer to the latest official information when operating.
Through the provision of AI Karte, Pottech serves as the optimal business partner for clinics—supporting not only better working conditions for physicians, nurses, and medical clerical staff, but also helping clinics achieve to the fullest what they want to accomplish.
For details, please do not hesitate to contact us.
References and Sources
- Ministry of Health, Labour and Welfare: On the FY2026 (Reiwa 8) Medical Fee Revision (notifications and notices)
- Tokai-Hokuriku Regional Bureau of Health and Welfare: On the FY2026 (Reiwa 8) Medical Fee Revision (facility-standard filings, etc.)
Note: The points, unit-count limits, facility standards (I–III), standard billing days, and reduction requirements of the locomotor rehabilitation fee (H002) change with medical fee revisions. When billing, be sure to confirm the latest point schedule, notices of points to note, and facility-standard notices published by the Ministry of Health, Labour and Welfare and the Regional Bureaus of Health and Welfare.