"How many points does the price response fee add to a first or follow-up visit?", "Which base fees does it go with?", "Do we need to notify it?" The price response fee, new in the FY2026 fee revision, touches almost every outpatient encounter, but its points are small and it is easy to overlook in receipt checks.
Based on the original text of the fee schedule (public notice) and the billing notice, this article explains the points, when it can be billed, and what to check for the outpatient/home-care price response fee that matters to clinics.
Disclaimer: This article is general information based on publicly available material as of October 29, 2026. The official notices of the Ministry of Health, Labour and Welfare (MHLW) are the authoritative source. For whether a specific case can be billed, consult your regional Bureau of Health and Welfare or the claims review organization.
What is the price response fee?
The price response fee is a new item in Part 14 ("Others"), Section 2 (code O100) of the medical fee schedule. The general rules state that "costs for price response are calculated by the points of each category in Section 2." The FY2026 notices have applied since June 1, 2026.
O100 has two parts:
- Outpatient/home-care price response fee (the subject of this article; relevant to clinics)
- Inpatient price response fee (billed per day for inpatients under inpatient basic fees and similar; for hospitals and clinics with beds, not covered here)
It is separate from the base-up evaluation fee in Section 1 of the same part. The base-up evaluation fee requires a facility-standard notification; the price response fee sits in a different section and should not be confused with it.
Points: 2 for first visit, 2 for follow-up, 3 for home visit
The points set in the fee schedule for the outpatient/home-care price response fee are:
| Category | Situation | Points |
|---|---|---|
| (i) | First visit | 2 |
| (ii) | Follow-up visit, etc. | 2 |
| (iii) | Home visit | 3 |
Which base fees allow billing
The billing notice states that the fee can be billed "when a first visit, follow-up visit or home visit is provided to a patient who visits the medical institution," and then limits each category to cases where specific base fees were billed.
| Category | Billable when this fee was billed |
|---|---|
| (i) First visit | First-visit fee (A000); pediatric outpatient fee, first-visit type (B001-2, 1(i)/2(i)); pediatric primary-care fee, first-visit type |
| (ii) Follow-up, etc. | Follow-up fee (A001); outpatient fee (A002); short-stay surgery basic fee 1 (A400, 1); pediatric outpatient fee, follow-up type; outpatient rehabilitation fee; outpatient radiation fee; community comprehensive care fee; pediatric primary-care fee, follow-up type; outpatient chemotherapy fee |
| (iii) Home visit | Home visit fee (I) (C001), home visit fee (II) (C001-2), comprehensive home cancer care fee (C003) |
In practice:
- In a typical clinic outpatient visit, the day you bill the first-visit fee gets category (i) (2 points), and the day you bill the follow-up fee gets category (ii) (2 points)
- Bundled fees such as the community comprehensive care fee or the pediatric outpatient fee also qualify if they are listed above (see pediatric outpatient billing for how bundling works)
- For home visits, category (iii) (3 points) is billed with the home visit fee (I)/(II) or the comprehensive home cancer care fee (see also home medical management fee billing)
- Add-ons to first-visit and follow-up fees are organized in first-visit fee additions and follow-up fee additions
Is notification required?
As far as this article could confirm:
- The O100 category in the fee schedule carries no facility-standard clause such as "when notified to the regional bureau as meeting the standards set by the Minister"
- The text of the basic and special medical-fee facility-standard notices (Hoi-hatsu 0305 Nos. 7 and 8) contains no price response fee item
So it appears to be designed as a fee billed whenever the listed base fee is billed, unlike the base-up evaluation fee, which requires notification. Handling may change with future notices or Q&A, so also check your regional bureau's guidance.
Clinics providing both medical and dental care
The general rules say that an institution providing both dental and non-dental care bills price response fees separately (dental outpatient price response fee and outpatient/home-care price response fee). However, the billing notice says that when a patient is seen by both departments for the same or related conditions, the fee is billed only in the primary department.
What the official Q&A says
Of the FY2026 Q&A documents (Nos. 1–14), three mention the price response fee (not detailed here):
- No. 8 (June 17, 2026): inpatient price response fee for short-stay surgery basic fee 3
- No. 9 (June 26, 2026): inpatient price response fee when moving from a DPC hospital to a community-based care ward
- No. 12 (September 2, 2026): dispensing price response fee for split dispensing (pharmacies)
In other words, we could not find Q&A in the documents available at the time of writing that directly answers clinic outpatient/home-care questions. For individual cases, asking your regional bureau is the safest route.
Receipt-check checklist
Because each unit is small, omissions and errors can add up.
- Is category (i) present on days when the first-visit fee was billed?
- Is category (ii) present on days when the follow-up or outpatient fee was billed?
- Is the right category present on days when bundled fees (community comprehensive care, pediatric outpatient) were billed?
- Is category (iii) present on home-visit days?
- Is it wrongly attached on days when only base fees outside the table were billed (tests or procedures only)?
- Is the EMR/billing software master updated for the FY2026 revision, and does it add the fee automatically?
For finding omissions, see the billing omission checklist; for the revision overall, see the FY2026 fee revision overview.
FAQ
Q. How many times per day can the fee be billed for one patient? A. The billing notice says the outpatient/home-care price response fee can be billed when the listed base fee is billed. Cases the notice text alone cannot settle, such as multiple visits in one day, should be confirmed with your regional bureau.
Q. Does the inpatient price response fee matter to clinics? A. It applies to inpatients billed under inpatient basic fees and similar. Institutions with beds, including clinics, should check the inpatient categories of the fee schedule.
Summary
- The outpatient/home-care price response fee is a new O100 item: 2 points for a first visit, 2 for a follow-up, 3 for a home visit
- It can be billed only when the listed base fee is billed
- As far as confirmed here, no facility standard is set and notification appears unnecessary, but check your regional bureau's guidance as well
- In receipt checks, verify the match with the base fee and look for omissions
Support for EMR and billing software
Small items that touch every encounter, like the price response fee, depend heavily on automatic billing and check mechanisms. Pottech supports clinics with EMR and receipt operations. Feel free to contact us, for example to confirm how your system handles the revision.
References
- MHLW, Public Notice No. 69 of 2026 (fee schedule), medical fee schedule Part 14, Section 2, O100 https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Health Insurance Bureau, billing notice (Hoi-hatsu 0305 No. 6, March 5, 2026), main text (applies from June 1, 2026) https://www.mhlw.go.jp/content/12400000/001666951.pdf
- Same, Attachment 1, Part 14 Others, Section 2 Price response fee https://www.mhlw.go.jp/content/12400000/001757385.pdf
- MHLW, facility-standard notification procedures for basic medical fees (Hoi-hatsu 0305 No. 7) https://www.mhlw.go.jp/content/12400000/001757361.pdf
- MHLW, facility-standard notification procedures for special medical fees (Hoi-hatsu 0305 No. 8) https://www.mhlw.go.jp/content/12400000/001757367.pdf
- MHLW, Q&A documents Nos. 8, 9 and 12 https://www.mhlw.go.jp/content/12400000/001712853.pdf , https://www.mhlw.go.jp/content/12400000/001716069.pdf , https://www.mhlw.go.jp/content/12400000/001744953.pdf
- MHLW, FY2026 fee revision notices page https://www.mhlw.go.jp/stf/newpage_67729.html