Key Takeaways
- Under the FY2026 fee schedule, a first visit by information and communication devices is 253 points (291 in person) and a follow-up is 76, the same as in person. Both require a filed facility standard.
- The outpatient management addition (52 points) cannot be billed for follow-ups by devices. A special fee for appointment-based care cannot be charged, but system operation costs can be charged separately.
- Management fees have separate device-based points. For a clinic, the specific disease management fee is 196 and the lifestyle disease management fee (II) is 290.
- Record in the chart and the claim summary column that care followed the online guidelines. The website must state that no narcotics or psychotropics are prescribed at a first visit.
"We want to start online consultations, but how many points can we bill under insurance?" "Do the points differ from in-person care?" "What happens to the outpatient management addition and management fees?" This article organizes the points and billing rules for care via information and communication devices under the FY2026 fee schedule, for clinic directors, office managers and billing staff.
Disclaimer: This article provides general information based on materials published as of November 12, 2026. The official public notices, notifications and administrative communications of the Ministry of Health, Labour and Welfare are authoritative for points, facility standards and billing requirements. Always confirm the latest original text or your regional bureau of health and welfare before filing or billing.
For the overall process of starting online care, including systems and pricing, see Getting Started with Online Medical Care in 2026. For a concrete system configuration at a psychosomatic clinic, see System Configuration for Starting Insured Online Consultation at a Psychosomatic Clinic. This article focuses on points and billing rules.
First-visit and follow-up fee points
Under the medical fee schedule (Appendix 1) of Ministry of Health, Labour and Welfare Notice No. 69 of 2026, the points are as follows.
| Item | In person | By information and communication devices |
|---|---|---|
| First-visit fee (A000) | 291 | 253 (proviso to Note 1) |
| Follow-up fee (A001) | 76 | 76 (Note 1 includes "follow-ups by information and communication devices") |
| Visiting a second department on the same day for another condition (first visit) | 146 | 127 |
Key points:
- The first-visit fee is 38 points lower, at 253. The follow-up fee is the same 76 points as in person.
- The device-based first-visit points can be billed only by a medical institution that has filed the facility standard set by the Minister with the regional bureau. Follow-ups by devices are likewise limited to filed institutions.
- The follow-up fee cannot be billed by hospitals with 200 or more general beds (Note 1).
- For other additions, such as the infant addition, check the notes in the fee schedule and the notifications individually. The outpatient management addition cannot be billed, as explained below.
The outpatient management addition cannot be billed
For follow-ups by information and communication devices, the notification (0305-6) treats them like the first-visit rule and states that "the outpatient management addition cannot be billed." For the concept of the addition (52 points added to the follow-up fee in person), see the outpatient management addition article. After filing, check that your EMR and billing software do not add it automatically to online follow-ups.
Management fee points "by information and communication devices"
Some management fees have separate points for care provided by information and communication devices. At a filed institution, when management follows the online guidelines, they are billed in place of the standard points. Main examples (for a clinic, from the original text of the fee schedule):
| Item | By devices | Notes |
|---|---|---|
| Specific disease management fee (B000) | 196 for a clinic (225 in person) | Hospitals: 128 under 100 beds, 76 for 100–199 beds |
| Dermatology specific disease guidance fee (B001-8) | (a) 218 / (b) 87 | |
| Nicotine dependence management fee 1 (B001-3-2) | (b) 2nd to 4th sessions: 155 | 184 in person |
| Lifestyle disease management fee (II) (B001-3-3) | 290 | 333 in person |
| Outpatient nutrition guidance fee 1 (B001-9) | First 235 / later 180 | In person: 260 first, 200 later |
| Home care guidance fee (B001-13) | 2nd and later: 148 | 170 in person |
Two additions are also set in the general rules of the fee schedule:
- Remote electronic prescription utilization addition: 10 points once a month. It applies when an electronic prescription is issued during care by devices, at an institution that has filed the facility standard. The notification requires all three of: checking the latest prescription and dispensing information through the electronic prescription management service and using its duplicate-medication check; confirming in advance the dispensing pharmacy and that it can dispense electronic prescriptions; and issuing an electronic prescription, not a paper one printed with a reference number. See also electronic prescriptions at clinics.
- Medical function coordination addition: 50 points once a month, for management fees provided by devices. It cannot be billed for management fees that have no device-based provision.
For the specific disease management fee, including in-person requirements, see Specific Disease Management Fee requirements. Other items also have device-based points, so check the fee schedule for the items relevant to your specialty before billing.
Prerequisite rules (billing notification)
The first-visit fee section of the notification (0305-6) sets the following for care by information and communication devices.
- Provide care following the online guidelines, and record the essentials (content, date and duration) in the chart.
- As a rule, the insured physician belonging to the institution provides it inside the institution. If provided outside, it must still follow the guidelines and the location must be verifiable afterwards.
- In emergencies, the institution responds as a rule. If it cannot (for example at night or on holidays), explain in advance where the patient can be seen promptly and record in the chart the family doctor's institution, or, if none, why in-person care is impossible, the referral destination and method, and the patient's consent.
- Maintain a system to provide in-person care and to cooperate with other institutions when difficult.
- Taking into account the Japan Medical Association Federation's "Symptoms unsuitable for first-visit online care" and similar material, record in the chart and in the summary column of the claim that the care followed the online guidelines. For prescriptions, likewise record that they were appropriate with reference to the Federation's "Drugs requiring careful consideration for first-visit online prescription."
- A special fee for appointment-based care cannot be charged.
- The cost of operating the devices can be charged separately as a service not directly related to the insured care.
In practice, deciding a template wording for the claim summary column and the chart before filing keeps operations stable.
Facility standard filing and display
Notification 0305-7 on basic fee standards sets the "facility standard for care by information and communication devices" as follows.
| Requirement | Content |
|---|---|
| Care outside the institution | If care outside is expected in advance, the location must meet the online guidelines and be verifiable afterwards |
| In-person capability | A system to provide in-person care |
| Cooperation | Able to cooperate with other institutions when in-person care is difficult |
| Website display | (1) That no psychotropics are prescribed at a first visit by devices, and (2) a checklist confirming compliance with the online guidelines, filled in with the institution's status |
| Medical advertising | Comply with the Medical Advertising Guidelines; refer to the case commentary on websites when building the site |
| Checks when prescribing psychotropics | Use the duplicate-medication check of the electronic prescription management service. Institutions without electronic prescriptions may instead confirm drug information through the online eligibility system or an inter-institution network until May 31, 2028 |
| Guideline-based system | A system to provide care following the online guidelines |
The filing uses Form 1 of Attachment 7. Website display is easy to overlook, so check it together with the reservation page and in-clinic notices before filing.
Key points of the online guidelines (revised April 2026)
The Ministry's "Guidelines for the Appropriate Implementation of Online Medical Care" were revised in April 2026 after the amended Medical Care Act, which took effect in April 2026, added general provisions on online care. Main points that bear directly on billing:
- First visits are in principle by a "family doctor." Care may also be given when the physician can grasp the history, medication, allergies and so on from past charts, referral letters, checkups, regional networks, medication notebooks or PHR, and judges it possible. Otherwise a pre-consultation is held for a first visit.
- Identity checks at first visits use, as a rule, photo ID (My Number card, driver's license, passport). Physicians also show their name with photo ID unless they are obviously the physician in context.
- No narcotics or psychotropics at first visits. Also no drugs requiring particular safety management for patients whose underlying conditions are unknown, and no prescription of 8 days or more.
For identity checks with the My Number card and two-factor authentication, see Two-factor authentication for online care.
Billing and accounting checklist
- The facility standard for care by information and communication devices is filed (Form 1 of Attachment 7)
- The website and clinic display no psychotropics at first visits and the guideline checklist
- Billing software can bill 253 first visits and 76 follow-ups separately from in-person care
- The outpatient management addition is not added automatically to online follow-ups
- The chart records content, date, duration and emergency arrangements (such as the family doctor's details)
- The wording for the chart and claim summary column stating care and prescriptions followed the guidelines is decided
- No special fee is charged for appointments. System operation costs are shown separately from insured care, with amount and basis
- If issuing electronic prescriptions, the facility standard and three requirements of the remote electronic prescription utilization addition are checked
For separating insured and self-pay accounting, see Separating insured and self-pay accounting.
FAQ
Q. What are the first-visit and follow-up points for online care? A. Under the FY2026 fee schedule, 253 for a first visit by devices (291 in person) and 76 for a follow-up (same as in person). Both require a filed facility standard.
Q. Can the outpatient management addition be billed? A. No. The notification states it cannot be billed for follow-ups by devices.
Q. Can reservation or communication fees be charged to patients? A. A special fee for appointment-based care cannot be charged. The cost of operating the devices can be charged separately as a service not directly related to the insured care.
Q. Can psychotropics be prescribed from the first visit? A. No. The guidelines prohibit prescribing narcotics and psychotropics at first visits, and the facility standard requires the website to state so.
Summary
- FY2026 points: 253 for first visits and 76 for follow-ups by devices, both requiring a filed facility standard
- Follow-ups carry the same points as in person, but the outpatient management addition cannot be billed
- Management fees have separate device-based points (for example 196 for the specific disease management fee at a clinic, 290 for the lifestyle disease management fee (II)), plus the remote electronic prescription utilization addition (10 points a month) and the medical function coordination addition (50 points a month)
- Record in the chart and the claim summary column that care and prescriptions followed the online guidelines
- A special fee for appointment-based care cannot be charged; system operation costs can be charged separately
- Check the facility standard's display requirements (no psychotropics at first visits, checklist) on the website before filing
Pottech provides an AI electronic medical record for clinics and a claim-checking function that reflects billing requirements. If you need help organizing billing settings for online care or operations between your EMR and billing software, please contact us.
Frequently Asked Questions
- Q. What are the first-visit and follow-up fees for online consultations?
- A. In the FY2026 fee schedule (Appendix 1 to the Calculation Method), a first visit by information and communication devices is 253 points (291 in person), and a follow-up is 76 points, the same as in person. Both require a filed facility standard.
- Q. Can the outpatient management addition be billed for online care?
- A. No. The notification states that the outpatient management addition cannot be billed for follow-ups by information and communication devices.
- Q. Can reservation or communication fees be charged to patients?
- A. Under the notification, a special fee for appointment-based care cannot be charged. The cost of operating the devices can be charged separately as a service not directly related to the insured care.
- Q. Can psychotropics be prescribed at a first online visit?
- A. No. The online guidelines prohibit prescribing narcotics and psychotropics at a first visit, and the facility standard requires the website to state that no psychotropics are prescribed at first visits.
- Q. Where do we file the facility standard?
- A. Notification 0305-7 on basic fee standards says the filing for care by information and communication devices uses Form 1 of Attachment 7, submitted to the regional bureau of health and welfare.
References
- Ministry of Health, Labour and Welfare, "FY2026 Medical Fee Revision" page, with Notice No. 69 of 2026 amending the Calculation Method and the medical fee schedule: https://www.mhlw.go.jp/stf/newpage_67729.html
- Ministry of Health, Labour and Welfare, Notification 0305-6 on implementation points for the Calculation Method, Attachment 1 (corrected October 7): https://www.mhlw.go.jp/content/12400000/001757385.pdf
- Ministry of Health, Labour and Welfare, Notification 0305-7 on basic fee facility standards and filing procedures (corrected October 7): https://www.mhlw.go.jp/content/12400000/001757361.pdf
- Ministry of Health, Labour and Welfare, "Guidelines for the Appropriate Implementation of Online Medical Care" (March 2018, revised April 2026): https://www.mhlw.go.jp/content/001685701.pdf
- Ministry of Health, Labour and Welfare Medical Policy Bureau Notice 0402-3, "Revision of the Guidelines for the Appropriate Implementation of Online Medical Care" (April 2, 2026): https://www.mhlw.go.jp/content/001685698.pdf