Key Takeaways
- In FY2026 the outpatient data submission addition was created as an addition to the community comprehensive care addition (Note 13 of the revisit fee) and the community comprehensive care fee (Note 4), at 10 points once a month.
- The former addition under Note 4 of the lifestyle disease management fee became the enhanced management addition 1–3 (30, 20 and 10 points) from June 2026, rewarding institutions with high performance.
- Billing requires form 7-10, two months of trial data, a ministry notice and form 7-11. For the community comprehensive care additions, the first deadline is November 20, 2026.
- If submission is late, the addition cannot be billed from the month after next, and three cumulative delays in a survey year require a change notification and end billing from the following month.
"We want to bill the outpatient data submission addition, but what changed in FY2026?" "Is the lifestyle disease fee's addition different from the community comprehensive care addition's?" "When is the filing deadline?" The FY2026 revision reorganized how outpatient data submission is evaluated. If you still think of it as "the lifestyle disease management fee's outpatient data submission addition," it is easy to mix up notifications and billing. Based on the FY2026 fee schedule (Public Notice No. 69), the implementation notice (Hoi-hatsu 0305 No. 6), the basic and specific fee facility standards notices (Hoi-hatsu 0305 No. 7 and No. 8) and the outpatient survey explanation material, this article summarizes the points, facility standards and notification steps.
Disclaimer: This article provides general information based on materials published as of October 31, 2026. The official public notices, notifications and administrative communications of the Ministry of Health, Labour and Welfare are authoritative for points, standards and deadlines. Always confirm final decisions against the latest original texts and your regional bureau's guidance.
Overview of the outpatient data submission addition (after FY2026)
The FY2026 revision organized data submission evaluations as follows.
| Addition | Applies to | Points |
|---|---|---|
| Outpatient data submission addition | Community comprehensive care addition (Note 13 of the revisit fee), community comprehensive care fee (Note 4) | 10 points once a month |
| Enhanced management addition 1 / 2 / 3 | Note 4 of the lifestyle disease management fee (I) and (II), by main disease (dyslipidemia, hypertension, diabetes) | 30 / 20 / 10 points |
| Home care data submission addition | Comprehensive home medical management fee (Note 13), facility version (applied via Note 5), comprehensive home cancer care fee (Note 7, once a month) | 50 points |
| Rehabilitation data submission addition | Cardiovascular, cerebrovascular, disuse, musculoskeletal and respiratory rehabilitation fees | (Not covered here) |
All require submitting data compliant with the ministry's annual "Survey on the impact of outpatient, home and rehabilitation care" (the outpatient survey). The inpatient "data submission addition" (A245) is a separate addition for DPC data (see below).
What changed
| Before | From June 2026 | |
|---|---|---|
| Note 4 of the lifestyle disease management fee (I)(II) | Outpatient data submission addition | Enhanced management addition 1–3 (three tiers by performance) |
| Community comprehensive care addition and fee | (None) | New 10-point outpatient data submission addition |
According to the ministry's revision materials, the aim was to reward institutions practicing in line with lifestyle disease guidelines and with high-quality management results, while simplifying the required data.
Requirements for the outpatient data submission addition
| Item | Handling (public notice and implementation notice) |
|---|---|
| Points | 10 points, once a month |
| Institutions | Those notified as meeting the standards. The community comprehensive care addition is limited to clinics; the fee to clinics and hospitals with fewer than 200 beds |
| Patients | Patients currently billed the community comprehensive care addition (or fee), only for outpatient care whose data is submitted |
| Purpose | Rewards accurate, continuous submission of survey-compliant data |
| Data unit | Three months. Data must include all applicable care from the first day of month 1 to the last day of month 3 |
| Relation to the enhanced management addition | Cannot be billed in a month when the enhanced management addition is billed |
The addition under Note 4 of the community comprehensive care fee follows that under Note 13 of the revisit fee.
Facility standards
The standards are the same in the basic fee notice (addition) and the specific fee notice (fee).
| Standard | Details |
|---|---|
| Survey participation | A system to properly participate in the outpatient survey; designate at least one contact reachable by email and phone by the Medical Economics Division and the survey secretariat |
| Data submission | Participate properly and submit survey-compliant data |
| Record retention | All medical records for the past five years and surgical and nursing records for the past three years are retained |
| Security | Preferably compliant with the Guidelines for Security Management of Medical Information Systems |
| Rules | Written rules for retaining and managing medical records |
| Disease classification | Disease statistics classified at least at the ICD chapter level |
| Search | Records can be searched and extracted by disease |
Facility standards for the enhanced management addition
The enhanced management addition shares the same data submission requirements; tiers 1 and 2 add performance requirements.
| Tier | Points | Performance requirement |
|---|---|---|
| 1 | 30 | Performance value by main disease in the top 20% of institutions filing for the addition |
| 2 | 20 | In the top 50% |
| 3 | 10 | None (data submission requirements only) |
Performance values are calculated when 10 or more patients with that main disease were managed during the period, from ratios such as:
| Main disease | Indicators (summary) |
|---|---|
| Dyslipidemia | Share of patients on continuous drug therapy who had lipid tests or a specific health checkup; share with continuous visits (each interval within six months) |
| Hypertension | Share with continuous visits |
| Diabetes | Share with HbA1c or a specific health checkup; share billed the ophthalmology or dental collaboration addition; share with continuous visits |
Transitional measures for institutions filed before the revision
- The facility standards notice treats the former Note 4 standard as renamed to enhanced management addition 3, with no new notification needed for institutions billing it on May 31, 2026
- Institutions filed under Note 4 on March 31, 2026 are deemed to meet tier 1's performance requirement until March 31, 2027
- For these institutions, tier 1 is listed as requiring notification "when continuing to bill on or after April 1, 2027"
Confirm which tier you can bill and when to file with your regional bureau.
Data to submit and frequency
The FY2026 survey explanation material lists four files.
| File | Content | Unit |
|---|---|---|
| Outpatient Form 1 | Patient attributes and conditions (sex, birth date, diagnoses, etc.) | Per patient, monthly |
| Outpatient EF integrated file | Outpatient medical claim information (E and F files combined) | Per patient, monthly |
| Outpatient Form 3 | Institution name, facility standard notifications, etc. | Per institution, monthly |
| Outpatient K file | Primary common ID generated from birth date, kana name and sex | Per patient, monthly |
- Patient data is anonymized before submission, using linkable anonymization with a correspondence table kept in the institution for queries
- One file of each type is created per month; the ministry's check program generates the submission file (one per month) when there are no errors
- Online submission is the rule; delivery is allowed when online is not possible
Patients covered by Outpatient Form 1
At institutions filed for the outpatient data submission or enhanced management addition, regardless of billing, patients who either (1) have at least one of diabetes, hypertension, dyslipidemia, chronic heart failure, chronic kidney disease or dementia as judged by a physician, or (2) are certified as needing long-term care or support. Institutions filed only for the enhanced management addition must include patients whose main disease is diabetes, hypertension or dyslipidemia; others are optional.
Submission schedule (FY2026 survey)
There are eight deadlines per survey year, and delays are judged at each.
| Target | Online deadline |
|---|---|
| April–May 2026 | July 30, 2026, noon |
| 1st query round | September 24, 2026, noon |
| June–September 2026 | October 29, 2026, noon |
| 2nd query round | December 24, 2026, noon |
| October–December 2026 | January 28, 2027, noon |
| 3rd query round | March 25, 2027, noon |
| January–March 2027 | April 30, 2027, noon |
| 4th query round | June 24, 2027, noon |
Separate, earlier deadlines apply to delivery.
Notification steps and schedule
You cannot file for billing right away. The steps are:
- File form 7-10 (notice of starting data submission) with the Director of the Medical Economics Division via the regional bureau's medical division (not the local office)
- Create and submit trial data for two months starting the month after the deadline month, using the check program, to the survey secretariat
- Receive the ministry's notice by email to the designated contact once the trial data is accepted
- File form 7-11 for the facility standard
- Start billing: per the revision materials, from the first day of the month after acceptance (or the same month if filed on the first business day)
Form 7-10 deadlines
| Addition | Deadlines |
|---|---|
| Outpatient data submission addition (community comprehensive care) | Nov 20, 2026; Feb 22, May 20, Aug 20, Nov 22, 2027; Feb 21, 2028 |
| Enhanced management, home care and rehabilitation data additions | The above plus May 20 and Aug 20, 2026 |
For the community comprehensive care additions, the first deadline is November 20, 2026. The Kanto-Shinetsu bureau states the trial data for that deadline covers December 2026 and January 2027. The Q&A of March 23, 2026 says institutions filing form 7-10 by November 20, recognized for trial data, and filing form 7-11 by April 1, 2027 can bill from April 2027.
Adding the outpatient addition when already filed for the enhanced management addition
The April 30, 2026 administrative notice says such institutions must file form 7-10 again. The enhanced management addition's main data for the quarter in which the filing is accepted (October–December if accepted by September 30, 2026) is treated as trial data, so it must also include patients covered by the outpatient data submission addition.
When submission is late
| Case | Handling |
|---|---|
| No submission or delay | Cannot bill from the month after next. Once submission is recognized again, billing resumes from the month after next |
| What "delay" means | Not submitted by the deadline (including submission by unapproved methods), or data differing from what is specified (including empty media) |
| Three cumulative delays | With three cumulative delays in a survey year, promptly file a change in the month of the third, and billing stops from the following month |
| Withdrawal or failing standards | File form 7-12 (withdrawal) |
| Restarting | Start again from form 7-10 |
Keep each file and its source data until the secretariat announces the end of the survey period, to respond to queries. Contact is by email, so build email checks into the contact's routine.
Differences from the home care and inpatient data submission additions
| Outpatient data submission addition | Home care data submission addition | Data submission addition (inpatient, A245) | |
|---|---|---|---|
| Applies to | Outpatient care with the community comprehensive care addition or fee | Comprehensive home medical management fees, comprehensive home cancer care fee | Inpatients under eligible basic or specific inpatient fees |
| Points | 10 points a month | 50 points | 145–225 points on the first day of admission, etc. (by category and bed size) |
| Survey | Outpatient survey | Outpatient survey | Inpatient (DPC) data |
The home care addition uses the same outpatient survey framework and the same form 7-10. Home care support clinic and hospital standards require filing for it when home visits exceed a certain number. The function enhancement addition's standards now state that filing for the outpatient or home care data submission addition is "desirable."
Pre-filing checklist
- Have you clarified whether you want the outpatient data submission addition (community comprehensive care) or the enhanced management addition (lifestyle disease)?
- Are you filed for the community comprehensive care addition or fee?
- Have you designated survey contacts (up to two) who can always check secretariat emails?
- Are five years of medical records retained, with written retention rules?
- Can you search records by disease and produce ICD chapter-level statistics?
- Have you confirmed with your EMR and billing system vendors that they can produce Outpatient Form 1 and the EF integrated file?
- Do you know the next form 7-10 deadline (November 20, 2026) and the trial data months?
- Are submission deadlines on the calendar, with operations aware of the three-delay limit?
- Is the system set not to bill the enhanced management and outpatient data additions in the same month?
FAQ
Q. How many points is the outpatient data submission addition? A. After FY2026, 10 points once a month as an addition to the community comprehensive care addition or fee. The lifestyle disease equivalent became the enhanced management addition 1–3 (30, 20 and 10 points).
Q. Was the lifestyle disease management fee's addition abolished? A. From June 2026, Note 4 became the enhanced management addition. The former standard is treated as renamed to tier 3, with no new notification for institutions billing it on May 31, 2026.
Q. When must we file? A. The first form 7-10 deadline is November 20, 2026. Per the Q&A, institutions recognized for trial data and filing form 7-11 by April 1, 2027 can bill from that month.
Q. What data is submitted? A. Outpatient Form 1, the EF integrated file, Outpatient Form 3 and the K file, created monthly and submitted via the check program.
Q. What if submission is late? A. Billing stops from the month after next. Three cumulative delays in a survey year require a change notification, and billing stops from the following month.
Q. If we are filed for the enhanced management addition, can we also bill the outpatient addition? A. You must file form 7-10 again (April 30, 2026 notice), and both cannot be billed in the same month.
Summary
- In FY2026, the outpatient data submission addition was created for the community comprehensive care addition and fee (10 points a month)
- The lifestyle disease fee's former addition became the enhanced management addition 1–3 (30, 20, 10 points) based on performance
- Billing requires form 7-10, two months of trial data, a ministry notice and form 7-11. The first deadline for the community comprehensive care additions is November 20, 2026
- Submitted files are Outpatient Form 1, the EF integrated file, Outpatient Form 3 and the K file, with eight deadlines a year
- Delays stop billing from the month after next, and three cumulative delays in a year require a change notification ending billing
For the community comprehensive care addition itself, see Community Comprehensive Care Addition; for choosing between lifestyle disease management fees, see Lifestyle Disease Management Fee I vs II. For basic internal medicine management fees, see Specific Disease Management Fee; for home care management fees, see Comprehensive Home Medical Management Fee; and for the full FY2026 revision, see Medical Fee Revision 2026.
Pottech provides AI electronic medical records and billing check functions for clinics that reflect billing requirements. If you have questions about using or exporting EMR data or organizing operations for filing these additions, please feel free to contact us.
Frequently Asked Questions
- Q. How many points is the outpatient data submission addition?
- A. After the FY2026 revision, it is an addition to the community comprehensive care addition or fee, worth 10 points once a month. The equivalent for the lifestyle disease management fee became the enhanced management addition 1–3.
- Q. Was the lifestyle disease management fee's addition abolished?
- A. Note 4 of the lifestyle disease management fee became the enhanced management addition from June 2026. Its former facility standard was renamed enhanced management addition 3, and institutions billing it on May 31, 2026 need no new notification.
- Q. When must we file to start billing?
- A. For the community comprehensive care additions, the first form 7-10 deadline is November 20, 2026. Per the Q&A, institutions recognized for trial data and filing form 7-11 by April 1, 2027 can bill from that month.
- Q. What data is submitted?
- A. Outpatient Form 1, the outpatient EF integrated file, Outpatient Form 3 and the outpatient K file, created monthly and converted into submission files with the check program.
- Q. What happens if submission is late?
- A. The addition cannot be billed from the month after next. Three cumulative delays in a survey year require a change notification and end billing from the following month.
参考・出典
- 厚生労働省「診療報酬の算定方法の一部を改正する件」（令和8年厚生労働省告示第69号）医科診療報酬点数表（A001 再診料の注12・注13、B001-2-9 地域包括診療料の注4、B001-3・B001-3-3 生活習慣病管理料の注4、C002 在宅時医学総合管理料の注13、C003 在宅がん医療総合診療料の注7、A245 データ提出加算） https://www.mhlw.go.jp/content/12400000/001686842.pdf
- 厚生労働省保険局医療課「診療報酬の算定方法の一部改正に伴う実施上の留意事項について」（令和8年3月5日保医発0305第6号）別添1（A001 外来データ提出加算、B001-2-9、B001-3 充実管理加算） https://www.mhlw.go.jp/content/12400000/001757385.pdf
- 厚生労働省「特掲診療料の施設基準等の一部を改正する件」（令和8年厚生労働省告示第71号）（地域包括診療料の注4、生活習慣病管理料の充実管理加算、在宅データ提出加算の施設基準） https://www.mhlw.go.jp/content/12400000/001675855.pdf
- 厚生労働省保険局医療課「特掲診療料の施設基準等及びその届出に関する手続きの取扱いについて」（令和8年3月5日保医発0305第8号）（第6の8 地域包括診療料3〜5、第6の9 生活習慣病管理料、表1・表4、様式7の10）（関東信越厚生局掲載） https://kouseikyoku.mhlw.go.jp/kantoshinetsu/tokkei080305.pdf
- 厚生労働省保険局医療課「基本診療料の施設基準等及びその届出に関する手続きの取扱いについて」（令和8年3月5日保医発0305第7号）（第2の3の2 外来データ提出加算）（九州厚生局掲載） https://kouseikyoku.mhlw.go.jp/kyushu/000476302.pdf
- 厚生労働省「令和8年度診療報酬改定 7.外来医療の機能分化・強化等」（生活習慣病管理料の見直し、診療実績データの提出に係る評価の見直し、外来様式1の見直し、地域包括診療加算等の見直し、機能強化加算の見直し） https://www.mhlw.go.jp/content/12400000/001681336.pdf
- 関東信越厚生局「外来／在宅／リハビリテーション データ提出加算及び充実管理加算に係る取扱いについて」（様式7の10の届出期限・試行データ作成対象月） https://kouseikyoku.mhlw.go.jp/kantoshinetsu/iryo_shido/gzr.html
- 厚生労働省保険局医療課「疑義解釈資料の送付について（その1）」（令和8年3月23日事務連絡）問5、「令和8年度における外来データ提出加算等の取扱いについて」（令和8年4月30日事務連絡）（関東信越厚生局掲載の抜粋） https://kouseikyoku.mhlw.go.jp/kantoshinetsu/r8gairai_extract.pdf
- 外来医療等調査事務局「2026年度『外来医療、在宅医療、リハビリテーション医療の影響評価に係る調査』実施説明資料」（2026年3月31日）（関東信越厚生局掲載） https://kouseikyoku.mhlw.go.jp/kantoshinetsu/080501_004.pdf