Key Takeaways
- The outpatient management addition is a 52-point addition under Note 8 of the follow-up visit fee (A001), for clinics and hospitals with fewer than 200 general beds; it cannot be added to the outpatient care fee of larger hospitals.
- It cannot be billed on days with procedures, rehabilitation, surgery, anesthesia, radiotherapy, psychiatric therapy, chronic pain management or the eight designated categories of physiological tests (such as ultrasound and endoscopy). Procedures count only if they carry fee points.
- Careful history-taking, a detailed physical examination and an explanation of the condition and self-care are required, with the key points recorded in the chart.
- It cannot be billed for telephone follow-ups, online follow-ups, second-department follow-ups (39 points), prescribing based only on a caregiver's report, quick repeat prescriptions, or on days the lifestyle disease management fee is billed.
"We know the addition cannot be billed on days with procedures, but which tests rule it out?" "Is it being added automatically to telephone follow-ups or second-department visits?" Because it attaches to follow-up visits day after day, the outpatient management addition is prone to both missed billing and overbilling. This article summarizes its points, requirements and the cases where it cannot be billed, based on the original texts of the FY2026 medical fee schedule (Public Notice No. 69), the implementation notice (Hoi-hatsu 0305 No. 6) and the basic medical fee facility standards (Public Notice No. 70).
Disclaimer: This article is general information based on publicly available information as of October 31, 2026. The MHLW public notices and notifications are the authoritative source for points and requirements. Always confirm the latest original text and the handling of your regional bureau of health and welfare and review body before making billing decisions.
Overview of the outpatient management addition
The outpatient management addition is defined in Note 8 of the follow-up visit fee (category A001). The implementation notice describes it as an addition that can be billed "when planned medical management is provided without procedures, rehabilitation and the like (limited to those carrying fee points)."
Points
| Item | Details |
|---|---|
| Points | 52 (added to the 76-point follow-up visit fee) |
| Basis | Follow-up visit fee (A001), Note 8 |
| Eligible patients | Outpatients (not inpatients) |
| Eligible institutions | Institutions billing the follow-up visit fee (clinics and hospitals with fewer than 200 general beds) |
| Notification | Not required (no notification provision) |
| Department | Billable regardless of the department advertised |
The follow-up visit fee is billed by clinics and hospitals with fewer than 200 general beds (Note 1, implementation notice). Hospitals with 200 or more general beds bill the outpatient care fee (A002) instead, and the implementation notice states that the outpatient management addition cannot be billed with the outpatient care fee. The addition belongs to the follow-up visit fee only; there is no outpatient management addition on the first-visit fee.
Billing requirements
Public notice: what must not be performed
Note 8 adds 52 points when planned medical management designated by the Minister is provided to an outpatient without any of the following:
- Chronic pain disease management
- Tests designated by the Minister (table below)
- Part 7: Rehabilitation
- Part 8: Psychiatric specialty therapy
- Part 9: Procedures
- Part 10: Surgery
- Part 11: Anesthesia
- Part 12: Radiotherapy
The basic medical fee facility standards (Public Notice No. 70) define "planned medical management" as management involving a careful and thorough explanation, without these services.
Tests designated by the Minister (eight categories)
Public Notice No. 70 and the implementation notice designate the tests in the following categories of physiological tests (Chapter 2, Part 3, Section 3).
| Designated test categories |
|---|
| Ultrasound tests, etc. |
| EEG tests, etc. |
| Nerve and muscle tests |
| Otorhinolaryngological tests |
| Ophthalmic tests |
| Load tests, etc. |
| Radioisotope tests |
| Endoscopy |
This list covers only some physiological test categories. Specimen tests such as blood tests, and the respiratory and circulatory function test category that includes the ECG (D208), are not on it. Procedures and rehabilitation also count only "if they carry fee points," so performing an act without fee points does not by itself rule out the addition.
Implementation notice: careful history, examination and explanation
The implementation notice requires the physician to take a careful history and perform a detailed physical examination (inspection, auscultation, percussion, palpation, etc.), then, while reconfirming the symptoms, explain the condition and self-care points thoroughly and take the following steps to resolve the patient's questions and concerns:
- Take the history and summarize the patient's complaints
- Explain the examination findings and the medical judgment based on them
- Explain and advise on self-care in light of the course of treatment so far
- Draw out the patient's unspoken questions and concerns
The physician performs those items considered necessary for the patient's condition; not every item must be met. However, the key points of what was heard from the patient and the examination findings must be recorded in the chart. Without them, there is no basis for the billing.
Additional notes on eligible situations
- It can be billed regardless of the department advertised
- When the house-call fee (C000) is billed, the outpatient management addition can also be billed in addition to the follow-up visit fee
Cases where it cannot be billed
The situations ruled out by the public notice and implementation notice are listed below.
| Situation | Handling | Basis |
|---|---|---|
| Procedures, rehabilitation, surgery, anesthesia, radiotherapy or psychiatric therapy (with fee points) performed | Not billable | Note 8, implementation notice |
| Designated tests (eight categories above) performed | Not billable | Note 8, Public Notice No. 70 |
| Chronic pain disease management provided | Not billable | Note 8 |
| Inpatients | Not billable | Note 8 |
| Telephone follow-up (Note 9) | Not billed | Note 9 |
| Follow-up using information and communication devices | Not billable | Implementation notice |
| Second department's follow-up on the same day (Note 3, 39 points) | Not billed | Note 3, implementation notice |
| In a multi-department institution, the patient visits several departments for two or more conditions and one department performs a procedure or surgery | Not billable in other departments either | Implementation notice |
| Medication prescribed after hearing symptoms only from a caregiver, for unavoidable reasons | Follow-up fee billable, addition not billable | Implementation notice |
| Repeat prescription after only a quick check of symptoms, without the history, examination and explanation, due to busyness | Follow-up fee billable, addition not billable | Implementation notice |
| Visit on a day the lifestyle disease management fee (I) or (II) is billed | Included in that fee | Implementation notice (B001-3, B001-3-3) |
| Hospitals with 200 or more general beds (outpatient care fee) | Not billable | Implementation notice (A002) |
For the lifestyle disease management fee, the implementation notice states that on days other than the billing day, the outpatient management addition can be billed if its requirements are met. Even within the same month, the handling depends on whether it is the billing day.
When the patient visits several departments on the same day
On days with follow-ups in several departments, check the two rules separately.
- Not added to the second department's fee (39 points): when the patient, by choice, visits another department for another condition on the same day, the second department bills 39 points and the additions in Notes 4–8 and 10–20 are not billed. This includes the outpatient management addition (Note 8).
- If one department performs a procedure or surgery, the others cannot bill it: in a multi-department institution, when an outpatient visits several departments for two or more conditions and one performs a procedure or surgery, the other departments cannot bill the outpatient management addition.
Changes in the FY2026 revision
Under the FY2026 public notice (effective June 1, 2026), the addition remains 52 points, and we found no significant change in the wording of Note 8 (the scope of excluded services), the implementation notice or the test categories in Public Notice No. 70. The MHLW revision overview (individual revision items) does not list the addition as revised.
Other follow-up visit additions did change, such as the reorganization of medical DX-related additions into the electronic clinical information coordination system addition. When you updated those settings, check that the automatic rules for the outpatient management addition were not disturbed. For all follow-up visit additions, see Follow-up Visit Fee Additions List.
Checklist for missed billing and billing errors
- Is the addition attached on follow-up days without procedures, rehabilitation or the eight designated test categories? (missed billing)
- Is it absent on days with procedures or rehabilitation carrying fee points, or tests such as ultrasound or endoscopy? (billing error)
- Are the key points of the history, examination findings and explanation recorded in the chart?
- Is it being added automatically to telephone or online follow-ups?
- Is it attached to a same-day second-department follow-up (39 points)?
- On multi-department days, did any department perform a procedure or surgery?
- Is it attached to prescriptions based only on a family member's report, or to quick repeat prescriptions?
- Is it attached on days the lifestyle disease management fee (I) or (II) is billed? (other days are billable if requirements are met)
Because the addition depends on "what was not done," automatic judgments linked to procedure and test orders are convenient, but errors tend to remain for procedures that are not ordered and for telephone or second-department follow-ups. We recommend a month-end review of claims against the conditions above.
FAQ
Q. How many points is the outpatient management addition? A. 52 points. It is defined in Note 8 of the follow-up visit fee (A001) and added to that fee. There is no outpatient management addition on the first-visit fee.
Q. Can it be billed on a day with blood tests or an ECG? A. The designated tests are eight categories of physiological tests (ultrasound, EEG, nerve and muscle, otorhinolaryngological, ophthalmic, load tests, radioisotope tests and endoscopy). Specimen tests and the ECG, which belongs to the respiratory and circulatory function test category, are not on the list. If the other requirements are met it may be billable, but confirm the handling of your review body as well.
Q. Is it unbillable if the consultation is short? A. The current public notice and implementation notice do not set a consultation-time requirement. What is required is the careful history, detailed examination and explanation, and a chart record of the key points. A quick symptom check followed by a repeat prescription is not billable.
Q. Can it be billed for telephone or online follow-ups? A. No. Note 9 rules it out for telephone follow-ups, and the implementation notice rules it out for follow-ups using information and communication devices.
Q. Can it be billed on a house-call day? A. Yes. The implementation notice states that when the house-call fee is billed, the addition can also be billed in addition to the follow-up visit fee.
Q. Did the FY2026 revision change it? A. It remains 52 points with no significant change in requirements, and it is not listed as a revised item in the revision overview.
Summary
- The outpatient management addition is a 52-point addition under Note 8 of the follow-up visit fee, for clinics and hospitals with fewer than 200 general beds; no notification is needed
- It cannot be billed on days with procedures, rehabilitation, surgery, anesthesia, radiotherapy, psychiatric therapy, chronic pain management or the eight designated test categories (procedures count only if they carry fee points)
- Take a careful history, perform a detailed examination, explain, and record the key points in the chart
- It cannot be billed for telephone follow-ups, online follow-ups, second-department follow-ups (39 points), prescribing based only on a caregiver's report, quick repeat prescriptions, or on lifestyle disease management fee billing days
- No revision was identified in FY2026; it remains 52 points
Related articles
- Follow-up Visit Fee Additions List: FY2026 Points, Outpatient Management Addition Rules and Combination Limits
- First-Visit Fee Additions List
- Lifestyle Disease Management Fee I vs II
- Specific Disease Management Fee Requirements
- Billing Easily Mistaken in Orthopedics
- Why Billing Is Missed: A Cause-by-Cause Checklist
- 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 checking whether the outpatient management addition should be attached based on procedures and tests, or reviewing settings after a revision, please feel free to contact us.
Frequently Asked Questions
- Q. How many points is the outpatient management addition?
- A. 52 points under the FY2026 medical fee schedule. It is defined in Note 8 of the follow-up visit fee (A001). There is no outpatient management addition on the first-visit fee.
- Q. What are the requirements?
- A. Planned medical management of an outpatient without procedures, rehabilitation or designated tests. The physician takes a careful history, performs a detailed physical examination, explains the condition and self-care, and addresses the patient's questions, recording the key points in the chart.
- Q. Can it be billed on a day with blood tests or an ECG?
- A. The designated tests are eight categories of physiological tests, including ultrasound, EEG, endoscopy and ophthalmic tests. Specimen tests such as blood tests and the ECG, which falls under the respiratory and circulatory function test category, are not on the list. Confirm the handling of your review body as well.
- Q. Can it be billed for telephone or online follow-ups?
- A. No. Note 9 excludes it for telephone follow-ups, and the implementation notice excludes it for follow-ups using information and communication devices.
- Q. What if the patient visits two departments on the same day?
- A. It is not added to the second department's follow-up fee (39 points). If one department performs a procedure or surgery, the other departments cannot bill it either.
- Q. Did the FY2026 revision change it?
- A. It remains 52 points, and we found no significant change in the requirements. The MHLW revision overview does not list it as a revised item.
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 注1・注3・注8・注9、A002 外来診療料） 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、1007訂正後）別添1（A001 再診料(1)(2)(4)(7)、A002 外来診療料(9)、B001-3 生活習慣病管理料（Ⅰ）(3)、B001-3-3 生活習慣病管理料（Ⅱ）(3)） https://www.mhlw.go.jp/content/12400000/001757385.pdf
- 厚生労働省「基本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70号）（医科再診料の外来管理加算に係る厚生労働大臣が定める検査及び計画的な医学管理） https://www.mhlw.go.jp/content/12400000/001675854.pdf
- 厚生労働省「令和8年度診療報酬改定について」個別改定事項 https://www.mhlw.go.jp/content/12400000/001681336.pdf
- 厚生労働省「令和8年度診療報酬改定について」（告示・通知・疑義解釈資料の掲載ページ） https://www.mhlw.go.jp/stf/newpage_67729.html