"What are the facility standards for the night/early morning addition?" "Do we have to notify the regional bureau?" "Can we bill it on Saturday afternoons or during Sunday consultation hours?" Clinic office managers and medical clerks often ask about this addition. In short, it can be billed by clinics only, and if the facility standards are met, no notification to the regional bureau of health and welfare is required (FY2026 facility standards circular). Whether the standards are actually met (total displayed hours, display outside the building) is something the clinic has to confirm for itself.
Based on the FY2026 (Reiwa 8) fee schedule and circulars, this article covers the points, facility standards, eligible times, additions that cannot be combined, and common mistakes. For the difference from the after-hours, holiday and late-night additions, see After-hours addition rules.
This article is general information based on publicly available documents as of October 25, 2026. Always check the latest public notices, circulars and guidance from your regional bureau of health and welfare before billing.
What it is (points and purpose)
- Points: 50 points added to both the initial visit fee and the follow-up visit fee (public notice, initial Note 9, follow-up Note 7).
- Eligible institutions: clinics only that meet the facility standards (hospitals are excluded).
- Purpose: per the circular, to reduce the burden on hospital physicians by encouraging local clinics to take in mild emergency patients, by evaluating clinic care in the evening, early morning and similar hours.
Facility standards (from the circular)
Section 1-2 "Night/early morning addition" of the basic medical fee facility standards circular (Hoi-hatsu 0305 No. 7) provides:
| Item | Content |
|---|---|
| Total displayed hours | A clinic with 30 or more displayed hours per week |
| Exception (emergency care cooperation) | 27 or more hours if, roughly once a month or more, a physician of the clinic goes to a designated emergency facility (regional medical support hospital, certified emergency hospital/clinic, institution in an emergency care program, etc.) and helps with night/holiday care; the same applies if the clinic itself is such an institution |
| Home visits | Regular home visits at fixed days or times may be counted only if those hours are displayed |
| Hours without a physician | Even if displayed, hours when no physician is routinely present (excluding time needed for home visits) are not counted |
| Where hours are displayed | Displayed outside the building and within the premises, making the available hours known to the community. If the clinic occupies part of a building, display outside the clinic |
| Notification | If the standards are met, no notification to the regional bureau director is required |
What counts as "displayed consultation hours"
The circular (initial visit (23)) defines displayed hours as hours announced to the community during which the clinic can always see patients who come in, or hours of planned home visits. These are not included:
- Hours when a visiting patient could not be seen (including regular school physician or occupational physician duties and attendance at community activities or events)
- Hours that are displayed but when no physician is routinely present, other than time needed for home visits
Eligible times
Under the public notice, the addition covers the following times within the clinic's displayed consultation hours.
| Category | Time |
|---|---|
| Night / early morning | 18:00 (Saturday: noon) to 8:00 (excluding late night and holidays) |
| Holiday | Sundays, national holidays, etc. (within displayed holiday hours) |
| Late night | 22:00 to 6:00 (within displayed late-night hours) |
For example, it applies when the clinic displays and keeps weekday evening hours, Saturday hours from noon, or early-morning hours, or when it displays holiday hours and sees patients then. Visits outside displayed hours are judged under the after-hours, holiday and late-night additions instead.
Judged by reception time
The circular (initial visit (23) item 5) says the addition is billed for patients received during an eligible time. It cannot be billed when consultation starts during an eligible time because of congestion from many patients or the institution's own circumstances (except unavoidable reasons).
Combination rules
| Situation | Treatment |
|---|---|
| After-hours, holiday, late-night additions and the special after-hours rule | Only one applies; not billed together with the night/early morning addition (circular) |
| Pediatric special rule for under-6 (initial Note 8, follow-up Note 6) | When it applies, the proviso in the public notice excludes the night/early morning addition |
| Home visit fee (C000) | The night/early morning addition can be billed in addition to the initial visit fee even when the home visit fee is billed (circular) |
| Contact lens exam fee, psychiatric night care, the Note 1 addition for artificial kidney, and the Note 1 addition for continuous slow hemofiltration | Not billed together with the night/early morning addition (circular) |
| Urgent in-house laboratory test addition (after hours) | Cannot be billed together (circular) |
| After-hours addition for procedures (General Rule 5) | Not applicable when it follows a visit billed with the night/early morning addition (procedures circular) |
| Infant addition (initial Note 6, follow-up Note 4) | The proviso excludes only the after-hours-type additions in Notes 7 and 8 (follow-up: Notes 5 and 6); the night/early morning addition is not listed as excluded |
For telephone follow-ups, when a patient or caregiver asks for medical advice by phone during after-hours, holiday, late-night or night/early morning times and instructions are given, the corresponding addition is billed. Follow-ups by fax or e-mail do not qualify (follow-up circular).
In-clinic checklist
- The facility is a clinic with 30+ displayed hours per week (27+ with emergency care cooperation)
- School physician or occupational physician duty hours, community events, and hours without a physician are excluded from the total
- Consultation hours are displayed outside the building and within the premises (outside the clinic for tenants)
- If home visit hours are counted, those hours are displayed
- The consultation hours master in the billing software matches what is displayed
- After-hours / holiday / late-night / night-early morning additions are mutually exclusive in the software
- Judged by reception time; not billed when delays came from congestion or internal circumstances
- Not attached to patients for whom contact lens exam fees or other excluded items are billed
FAQ
Q. Do we need to submit a notification form to the regional bureau? A. The FY2026 facility standards circular (Hoi-hatsu 0305 No. 7) states that meeting the standards is sufficient and no notification to the regional bureau director is needed. If a clinic operates on the assumption that only "notified" clinics can bill it, as with other additions, it may leave the addition unbilled despite meeting the standards, or bill it without checking them.
Q. We display Saturday afternoon hours. Can we bill it? A. On Saturdays, noon to 8:00 is eligible. If Saturday afternoon is within your displayed hours and the clinic meets the standards, you can bill it.
Q. We open on Sundays and holidays as regular days. Holiday addition or this one? A. Patients who visit during the displayed hours of a clinic open on that holiday are outside the holiday addition (circular). If the standards are met, the night/early morning addition applies.
Q. We were busy and started a consultation after 18:00. Can we bill it? A. Not unless reception itself was in an eligible time. It cannot be billed when congestion or the institution's circumstances caused consultation to start in eligible hours.
Q. Is this the same as the after-hours response system addition or the function strengthening addition? A. No. The after-hours response system addition rewards phone-inquiry arrangements on the follow-up fee and requires notification (details). The function strengthening addition applies to initial visits and requires notification (details).
Summary
- The night/early morning addition is 50 points on initial and follow-up visits billed by clinics for night, early morning, holiday and late-night care within displayed hours.
- The facility standards are 30+ displayed hours per week (27+ with emergency care cooperation) and hours displayed outside the building within the premises. No notification to the regional bureau director is required.
- It is mutually exclusive with the after-hours, holiday and late-night additions. Judge by reception time, and do not bill when delays came from congestion or internal circumstances.
For the full lists of additions, see the initial visit fee additions and follow-up visit fee additions. The billing omission checklist is also useful for review. Pottech supports clinics with EMR and billing software operations, including reviewing consultation-hour and addition settings. Please feel free to contact us.
References
- MHLW, Public Notice No. 69 of Reiwa 8 (revision of the fee calculation method), Medical Fee Schedule A000 Initial Visit Notes 6-9, A001 Follow-up Visit Notes 4-7. https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Insurance Bureau, Circular on implementation (Hoi-hatsu 0305 No. 6, March 5, Reiwa 8), Attachment 1, Part 1 Section 1 Initial visit (21)-(23), Section 2 Follow-up visit (6), Part 3 Tests, Part 9 Procedures. https://www.mhlw.go.jp/content/12400000/001757385.pdf
- MHLW Insurance Bureau, Circular on facility standards for basic medical fees and notification procedures (Hoi-hatsu 0305 No. 7, March 5, Reiwa 8), Section 1-2 Night/early morning addition (posted by Kyushu Bureau of Health and Welfare). https://kouseikyoku.mhlw.go.jp/kyushu/000476302.pdf