The medical fee revision, which comes once every two years, is an important event directly tied to a clinic's revenue and practice. The FY2026 (Reiwa 8) medical fee revision centers on wage-increase support for medical workers, responding to inflation, and promoting medical DX. This article explains the overall picture of how Medical Fee Revision 2026 affects clinics and practical countermeasures, based on the official materials of the Ministry of Health, Labour and Welfare (MHLW). Note that specific points and requirements are set in the revision notices and notifications, so always confirm them in the primary sources.
The overall picture of Medical Fee Revision 2026
According to MHLW materials, the FY2026 medical fee revision is structured to raise the main body of medical fees while lowering drug prices and the like. A major feature of the revision is that, rather than centering on system reviews as in the past, wage-increase support for medical workers and responses to inflation make up the bulk of the revision. Responding to the immediate management environment of rising labor costs and prices is the keynote of this revision.
The timing of enforcement and the specific revision rates are officially published by MHLW. For accurate figures, please confirm in the MHLW's "About the FY2026 Medical Fee Revision" cited below.
The main changes clinics should grasp
The revision has many pillars, but here we organize the points that clinics, mainly outpatient-focused, should especially grasp.
The following organizes reported and published analysis. Always confirm specific point values and requirements in the official notices.
1. Fundamental reorganization of medical DX-related fees
The change with the largest impact on clinics in this revision.
The medical information acquisition fee and the medical DX promotion system development fee were abolished and consolidated into the electronic clinical information coordination fee. The old fees ended May 31, 2026, and the new fee became billable from June 1, 2026.
Even institutions that had filed for the old fees must file again—migration is not automatic. Facility standards are tiered according to support for electronic prescriptions and the EMR information sharing service.
Details in Medical DX-Related Fees in the 2026 Revision.
2. Revision of the lifestyle disease management fee
A change that bears directly on internal medicine clinics.
- The patient signature on the treatment plan is no longer required. What disappeared is only the signature field and the act of obtaining it—creating, explaining, and delivering the plan remain necessary
- A fee evaluating referral coordination to ophthalmology and dentistry for diabetic patients was newly established
- An enhanced management fee evaluating management based on outpatient data was newly established
- The bundled scope was revised and testing-related requirements added
See Auto-Generating the Treatment Plan from the Chart and What Changed in the 2024 Revision.
3. Responding to wage increases and improved treatment
The outpatient and home-care base pay evaluation fee was raised, and its scope of eligible staff was expanded. Previously covering staff primarily engaged in medical care, it now extends to staff employed at the institution, including administrative personnel.
Billing involves notifications and requirements—confirm whether your clinic is eligible and whether filing is needed.
4. Functional differentiation in outpatient care
- A referral acceptance fee was newly established for clinics and hospitals under 200 beds accepting first-visit patients referred from large hospitals
- Reverse referral ratio standards for specified functional hospitals were raised, pushing functional differentiation harder
- Requirements for the enhanced functionality fee were also tightened
Clinics coordinating with regional large hospitals should take this as an occasion to review referral operations.
5. Higher patient burden for long-listed brand drugs
The "special charge" when a patient requests a brand-name drug without medical necessity rose from one quarter to one half of the price difference against the generic (from June 1, 2026). Front-desk explanation and in-clinic posting need updating.
See Separating Insured and Self-Pay Accounting in Practice.
6. Responding to inflation
Responses reflecting price increases are also woven into the revision. You need to grasp the impact on your daily cost structure from a management perspective.
Practical countermeasures clinics should take
To reliably respond to the revision, we recommend taking the following steps.
- Confirm MHLW's primary sources: Revision content is shown in notices, notifications, and explanatory materials. Confirm it in official materials, not hearsay.
- Identify items relevant to your clinic: In light of your department and the items you bill, identify the points and add-ons affected.
- Confirm items requiring notification: Some newly created or changed evaluation fees require notification. Confirm this, including deadlines.
- Confirm your system's revision handling: Confirm whether your electronic chart and receipt computer support the revision, and the update method and timing.
- Check for billing omissions and claim errors: The period right after a revision is prone to billing mistakes. Strengthen your checking system.
Points 4 and 5 are especially important. Operations that manually update the system with each revision, or have staff memorize the changes one by one, become a breeding ground for billing omissions and claim errors.
Handling revisions with AI Karte
"AI Karte," developed by Pottech, is an integrated receipt-computer cloud electronic chart in which the system is automatically updated in line with each medical fee revision. There is no need for the clinic to perform manual updates, greatly reducing the effort and error risk of revision handling.
Furthermore, an AI receipt checking function detects billing omissions and erroneous claims in advance, in line with the post-revision billing rules. Even during the easily confused period right after a revision, the system provides constant support for billing, keeping down the risk of revenue leakage and returned claims. It also supports, in an integrated way, building medical DX-related structures such as online eligibility verification, electronic prescriptions, and the electronic chart information sharing service.
In closing
Medical Fee Revision 2026 is a revision centered on wage-increase and inflation responses and the promotion of medical DX. The responses clinics should take come down to confirming official materials, identifying the impact on your clinic, filing notifications, and preparing your systems and checking structure. To reduce the burden of revision handling and prevent billing omissions, a mechanism that automatically handles revisions is effective.
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 / Sources
- Ministry of Health, Labour and Welfare, "About the FY2026 (Reiwa 8) Medical Fee Revision" https://www.mhlw.go.jp/stf/newpage_67729.html
- Ministry of Health, Labour and Welfare, "About Explanatory Materials for the FY2026 Medical Fee Revision" https://www.mhlw.go.jp/stf/newpage_71068.html
- Ministry of Health, Labour and Welfare, "About the FY2026 Medical Fee Revision [Overall Summary]" https://www.mhlw.go.jp/content/12400000/001701061.pdf
- Ministry of Health, Labour and Welfare, "Basic Policy for the FY2026 Medical Fee Revision" https://www.mhlw.go.jp/stf/newpage_66800.html