"Can our clinic apply for the outpatient infection control addition?" "Can we always bill 20 points for a patient with a fever?" "What is the difference between the three add-ons?" Clinic directors, administrators and medical clerks ask these questions often. This article organizes points, billing rules, facility standards and notification from the FY2026 medical fee schedule (public notice), the billing notice (Hoi-hatsu 0305 No. 6) and the facility standards notice for basic medical fees (Hoi-hatsu 0305 No. 7).
Disclaimer: This article is general information based on public materials as of October 18, 2026. Points, billing requirements, facility standards and notification procedures are governed by the MHLW's public notices and circulars and the guidance of your regional Bureau of Health and Welfare. Always check the latest original text and your regional bureau before billing or notifying.
Overview of the addition
The outpatient infection control addition evaluates a clinic's system for infection control during outpatient care: routine infection prevention, participation in community infection control activities, and care of patients with fever and similar symptoms under appropriate measures, including spatial and temporal separation (billing notice). Only clinics that have notified can bill it. Hospitals are not eligible.
Points
| Addition | Points | Frequency | Prerequisite |
|---|---|---|---|
| Outpatient infection control addition | 6 | Once a month per patient | Facility standard notification |
| Fever patient response addition | 20 | Once a month | The outpatient infection control addition is billed |
| Cooperation enhancement addition | 3 | Once a month | Same; notified on Form 1-5 |
| Surveillance enhancement addition | 1 | Once a month | Same |
| Antimicrobial stewardship system addition | 5 | Once a month | Same |
They are billed with the initial consultation fee (Notes 11–14) and the follow-up consultation fee (Notes 15–18). Similar provisions apply to the general rules of Medical Management (when billing items such as the pediatric outpatient fee, outpatient rehabilitation fee, outpatient radiotherapy fee, comprehensive community care fee, pediatric family doctor fee, outpatient chemotherapy fee, emergency life-saving management fee or post-discharge home guidance fee), Home Medical Care, and Psychiatric Home-Visit Nursing.
Only once a month
The billing notice says that once the addition is billed in a month under any of the initial fee, follow-up fee, medical management, home medical care or psychiatric home-visit nursing, it cannot be billed again that month under another category. A patient billed 6 points at the initial visit early in the month cannot be billed again at a follow-up visit in the same month. Check the monthly count rule in your billing software.
Fever patient response addition (20 points)
This addition can be billed when the outpatient infection control addition is billed and the patient has fever, respiratory symptoms, rash, gastrointestinal symptoms, neurological symptoms or other symptoms suggesting infection, and the patient is seen under appropriate infection control, including spatial and temporal separation (once a month, initial or follow-up).
| Situation | How to bill |
|---|---|
| Patient with symptoms seen with separated flow | 6 points plus 20 points |
| Patient without symptoms | 6 points only |
| Both initial and follow-up visits qualify in one month | Once only |
The requirement is not just "a patient with a fever" but that infection control measures such as separation were actually taken. Record how you separated patients (a separate room, separate time slots, examination in the car, etc.) in the chart or the internal manual so you can explain it later.
Facility standards
The facility standards notice (Hoi-hatsu 0305 No. 7, Section 1-4) requires all of the following.
| Area | Main requirement |
|---|---|
| Organization | The facility is a clinic. An infection control department is established (the medical safety management department may double as it) |
| Staff | A dedicated physician, nurse, pharmacist or other qualified staff member is assigned to the department as the infection control manager and handles daily infection control tasks. This person cannot also be the medical safety manager |
| Documents | Operating guidelines and the manager's specific duties are in place. A manual covering standard precautions, transmission-based precautions, cleaning/disinfection/sterilization and antimicrobial stewardship is written and distributed to each section |
| Training | The manager provides infection control training to staff at least about twice a year (separate from the safety management training) |
| Cooperation | The manager attends conferences hosted by an Infection Control Addition 1 hospital or the local medical association about twice a year (when cooperating with several Addition 1 hospitals, at least once a year with each and twice or more in total). Attendance at a drill assuming an emerging infectious disease is required at least once a year. Conferences may be held by video call |
| Antimicrobials | The clinic receives advice on antimicrobial stewardship from the cooperating Addition 1 hospital or association, and takes actions with reference to MHLW's "Manual of Antimicrobial Stewardship" |
| Rounds | The manager makes rounds about once a week to monitor infection cases and the status of preventive measures |
| Posting | Infection control measures are posted in a visible place |
| Fever patients | The clinic publicly states that it accepts patients with fever or suspected infection regardless of visit history, and can separate flow spatially and temporally |
| Emerging infections | The clinic is a Category 2 designated medical institution under Article 38, paragraph 2 of the Infectious Diseases Control Act (with fever outpatient measures) |
| Emergency cooperation | Cooperation for emerging infections or outbreaks has been discussed in advance with an Addition 1 hospital, etc. |
The notice also says it is desirable (not required) to have a system for patients with persistent post-infection symptoms, such as detailed examination or referral to specialists. The clinic must also not have notified Infection Control Improvement Addition (hospital) standards.
Notification requires no track record: no past billing results are needed if the system is in place.
Typical stumbling blocks for small clinics
- A dedicated infection control manager: it cannot be the same person as the medical safety manager. Decide who to appoint first.
- Securing a partner: attending conferences twice a year and receiving advice requires a cooperating Addition 1 hospital or a local medical association.
- Category 2 designation: a designation by the prefectural governor is needed. The form has a field for the local government webpage that publishes it.
The three add-ons
All require that the outpatient infection control addition is billed, and are notified on Form 1-5.
| Addition | Points | Key requirement |
|---|---|---|
| Cooperation enhancement | 3 | Reports on infection occurrence and antimicrobial use to the cooperating Addition 1 hospital four or more times in the past year |
| Surveillance enhancement | 1 | Participates in regional or national surveillance such as JANIS or J-SIPHE |
| Antimicrobial stewardship system | 5 | Participates in surveillance that can monitor antimicrobial use, and in the last six months Access antibiotics make up 60% or more of antimicrobials used, or the clinic is in the top 30% of participating clinics |
Because the last one is judged by numbers, you need to be able to compute the Access-antibiotic ratio from claims and prescription data before notifying.
Notification steps
- Check each facility standard above and plan for gaps
- Prepare the "Attached document for outpatient infection control addition notification" (Attachment 7, Form 1-4): the infection control manager's name and job, the antimicrobial stewardship measures (advice from the partner), the partner hospital or local medical association, fever patient response, and Category 2 designation
- Attach documents: proof that the infection control department exists, a document with the guidelines and manager's duties, and a manual including standard precautions and flow separation
- To notify the three add-ons, add Form 1-5
- Submit to your regional Bureau of Health and Welfare
Under the general rule in the notice, if the review is completed and the notification accepted by the end of a month, billing can start on the 1st of the following month. Submission methods and deadlines differ among regional bureaus, so check your bureau's guidance.
Internal checklist
- Appointed an infection control manager who is not the medical safety manager
- Documented the department, guidelines and the manager's duties
- Wrote and circulated manuals for standard precautions, transmission-based precautions and flow separation
- Planned about two in-house trainings a year
- Chose the partner Addition 1 hospital or local medical association and confirmed conference and drill schedules
- Confirmed Category 2 designation status
- Publicly stated that fever patients are accepted and posted the measures in the clinic (and on the website)
- Assigned weekly rounds and a record method
- Submitted Form 1-4 (and Form 1-5 if needed)
- Set the once-a-month limit and the fever addition input rule in the billing software
FAQ
Q. Can any clinic without beds notify? A. Being a clinic is only one condition. You must meet all of the requirements in the notice, such as an infection control manager, training, discussions with a partner and Category 2 designation.
Q. Do we need billing results or a minimum operating period before notifying? A. The facility standards notice says no track record is required for this notification. If the system and documents are in place, you can notify.
Q. Can we bill only the fever patient response addition? A. No. It can be billed only when the outpatient infection control addition is billed.
Q. Can we bill 6 points separately for initial and follow-up visits? A. No. If it was billed in one category in a month, it cannot be billed in another category that month.
Summary
- The outpatient infection control addition is for clinics: 6 points once a month at initial and follow-up visits. The 20-point fever patient response addition requires it.
- The cooperation enhancement (3), surveillance enhancement (1) and antimicrobial stewardship system (5) additions are notified separately on Form 1-5.
- The core standards are a dedicated infection control manager, training and cooperation conferences about twice a year, weekly rounds, accepting fever patients with separated flow, and Category 2 designation. No track record is required.
- Make sure your billing software also blocks repeated billing in the same month under different categories.
For other additions to the initial consultation fee, see Function Strengthening Addition; for internal medicine clinics, see the Community Comprehensive Care Addition article; for the full picture of the FY2026 revision, see Medical Fee Revision 2026. For the pediatric lump-sum fee, see Pediatric Outpatient Billing; for operations that prevent missed billing, see Why Billing Is Missed: A Cause-by-Cause Checklist.
Pottech provides AI electronic medical records and billing check functions for clinics. If you have questions about preventing missed billing for new or changed additions, or checking monthly billing counts, please feel free to contact us.
References
- MHLW, "Partial Revision of the Fee Schedule for Medical Treatment" (FY2026 MHLW Public Notice No. 69), medical fee schedule (initial consultation Notes 11–14, follow-up consultation Notes 15–18, Medical Management General Rules 3–6) https://www.mhlw.go.jp/content/12400000/001686842.pdf
- MHLW Health Insurance Bureau, "Implementation points for the partial revision of the fee schedule" (March 5, 2026, Hoi-hatsu 0305 No. 6, 1007 corrected version), Attachment 1 https://www.mhlw.go.jp/content/12400000/001757385.pdf
- MHLW Health Insurance Bureau, Medical Care Division, "Handling of facility standards for basic medical fees and notification procedures" (March 5, 2026, Hoi-hatsu 0305 No. 7) (Sections 1-4 to 1-7; Attachment 7 Forms 1-4 and 1-5) (published by the Kyushu bureau) https://kouseikyoku.mhlw.go.jp/kyushu/000476302.pdf