Obstetrics Management Addition 2026: Requirements and Notification
"Can our clinic with beds bill the Obstetrics Management Addition?" "Do we need an Advance Midwife to notify?" "From which day can we bill?" Directors, administrators and billing staff at facilities that handle deliveries ask these questions often. This article organizes the addition newly created in the FY2026 (Reiwa 8) medical fee revision — points, eligible patients, facility standards and notification — based on the Ministry of Health, Labour and Welfare (MHLW) revision materials, Q&A notices and the notification checklist.
Disclaimer: This article is general information based on publicly available material as of November 4, 2026. The official notices from MHLW and the guidance of your regional Bureau of Health and Welfare are authoritative. Always confirm the latest originals and your Bureau before notifying or billing.
Overview
As deliveries decline, obstetric wards increasingly become mixed wards that also admit patients from other specialties. In response, the addition evaluates a system that secures the physical and mental stability and safety of mother and child, and provides delivery-related care in cooperation with in-hospital midwifery, midwife-led outpatient clinics and maternal-child health programs such as postpartum care.
| Item | Details |
|---|---|
| Points | Per day. Addition 1 (hospitals): 250 points; Addition 2 (clinics with beds): 50 points |
| Eligible patients | Inpatients with delivery (only from the day delivery begins) |
| Notification | Listed as a new facility standard effective June 1, 2026 |
At ¥10 per point, this equals ¥2,500 per day for hospitals and ¥500 per day for clinics with beds.
From which day can you bill?
Billing is limited to the day delivery begins and after. The Q&A notice of March 23, 2026 (Q15) states:
- The day of admission, when onset of labor is recognized as the start of delivery, may be included
- For a scheduled cesarean section without labor onset, the addition can be billed from the day that includes the start time of surgery
Because the addition accumulates per day, decide in advance how your billing system treats the start date to avoid omissions and over-billing.
Key facility standards
| Type | Obstetric patients and newborns only | Mixed with other specialties |
|---|---|---|
| Hospital (Addition 1) | At least half of the minimum required nursing staff are midwives; at least one midwife on duty at all times; adequate number of midwives | At least one midwife at all times; designated obstetric area (unit); adequate midwives assigned to the area |
| Clinic with beds (Addition 2) | Adequate number of midwives | Designated obstetric area where possible (zoning); adequate midwives assigned to the area |
Common requirements:
- At least one dedicated midwife with five or more years of experience in midwifery or care of obstetric patients and newborns, and in regional-coordination duties
- Prenatal care in outpatient settings: prenatal checkups and health guidance, including midwife-led clinics (hospitals also need midwives in obstetric outpatient care)
- Desirable items: an in-hospital midwifery unit and a postpartum care program (both described as "desirable")
For hospitals with mixed wards, the area must be structurally separated (for example, with doors) and visually divided so that patients from other specialties do not normally enter.
Unit vs. zoning
The MHLW materials describe a "unit" as using part of a continuous ward as a dedicated obstetric unit, and "zoning" as designating a contiguous area, including corridors, solely for obstetrics. For clinics with beds that admit both obstetric and other patients, designating an obstetric area is required "where possible."
Confirmed in the Q&A notices
| Issue | Handling |
|---|---|
| Certified dedicated midwife | For now, a midwife certified as "CLoCMiP Level III" (Advance Midwife) by the Japan Midwifery Evaluation Organization (Mar. 23, Q16) |
| In-hospital midwifery / midwife clinic | Refer to the "In-hospital Midwifery and Midwife Outpatient Guidelines 2018"; clarifying physician–midwife roles is desirable (Q17) |
| Designated obstetric area | Facilities that physically or visibly separate the area so other patients do not enter by mistake (Q18) |
| Multiple obstetric wards (Addition 1) | Each ward may notify if it meets the standards; the dedicated midwife is preferably placed per ward, but one or more across the hospital is acceptable if working cross-wards (Q19) |
| Five years' experience | Experience in a regional-coordination department is not strictly required; it can count if sharing information with maternal-child health or welfare staff was part of the job (May 8, Q2) |
Because the Q&A says "for now," the treatment of Advance Midwives may be revised. Check the latest notices before notifying.
Pre-notification checklist
- Confirm whether you are a hospital or a clinic with beds (with the inpatient basic fee notified)
- Decide whether you admit only obstetric patients or also other specialties
- If mixed, confirm you can physically and visually separate the obstetric area
- Secure a dedicated Advance Midwife and organize the five-year experience
- Confirm the prenatal checkup and guidance system, including midwife clinics
- Confirm an adequate number of midwives
- Define in your system how the delivery start date (labor-onset admission / start of cesarean) is recorded
- Check forms and submission destination with your regional Bureau
Daily operations
- Because the delivery start date triggers billing, record the time of labor onset and the surgery start time in the chart.
- As days accumulate, claim review should match the start date and number of billed days. See the billing omission checklist.
- Basics are in What is a receipt (rezept); returns are covered in Return reasons and resubmission.
- For specialty trends see FY2026 fee revision for OB/GYN; for EMR selection see Comparing EMRs for OB/GYN clinics; for public-funded checkups see OB/GYN checkups and public funding.
FAQ
Q. Can a clinic without beds bill it? A. The materials define hospitals (Addition 1) and clinics with beds (Addition 2). Because the target is inpatients, clinics without beds appear to be excluded.
Q. Can we notify without an Advance Midwife? A. The Q&A states that, for now, the dedicated midwife is one certified as CLoCMiP Level III. If you cannot secure one, consult your regional Bureau.
Q. Do we need in-hospital midwifery or postpartum care programs? A. The materials describe them as "desirable," not mandatory.
Summary
- The Obstetrics Management Addition is new in FY2026: 250 points/day for hospitals and 50 points/day for clinics with beds
- Billable from the day delivery begins — labor-onset admission, or for a scheduled cesarean, the day containing surgery start
- Main requirements: a dedicated Advance Midwife, a designated obstetric area and prenatal care including midwife clinics
- Confirm notification procedures with your regional Bureau and the latest Q&A
Contact Pottech
How the start date is managed, and how chart entries are matched with claims, changes the workload significantly depending on system design. Pottech helps medical institutions organize EMR and billing operations. Feel free to contact us.
References
- MHLW, FY2026 Medical Fee Revision, "10. Priority areas (emergency, pediatric and perinatal care)" https://www.mhlw.go.jp/content/12400000/001680843.pdf
- MHLW Insurance Bureau notice, March 23, 2026 (Q&A, Obstetrics Management Addition Q15–19) https://www.mhlw.go.jp/content/12400000/001678310.pdf
- MHLW Insurance Bureau notice, May 8, 2026 (Q2) https://www.mhlw.go.jp/content/12400000/001698587.pdf
- MHLW notification checklist (attached to the May 29, 2026 notice) https://www.mhlw.go.jp/content/12400000/001706142.pdf