"Which patients can we bill the treatment-work balance support guidance fee for?" "What changed in the FY2026 revision?" "The consultation support addition went from 50 to 400 points—do we need to notify?" These questions come up often at clinics that see working patients with cancer, diabetes, heart disease and other conditions requiring ongoing treatment. Based on the Ministry of Health, Labour and Welfare (MHLW) revision overview, the MHLW Labour Standards Bureau notices (Ki-an-rou-hatsu 0305 Nos. 2 and 3), and the facility-standards circular for special medical treatment fees (Hoi-hatsu 0305 No. 8), this article organizes the billing requirements and notification points.
Disclaimer: This article provides general information based on publicly available information as of October 16, 2026. The MHLW's public notices and circulars, and the guidance of your regional bureau of health and welfare, are authoritative for points, billing requirements, facility standards and notification handling. Always confirm the latest original text and your regional bureau before making a final decision on billing or notification.
For the overall revision, see Medical Fee Revision 2026: Changes Clinics Should Know, and for internal medicine highlights, see Fee Revision: Internal Medicine.
Conclusion: what changed from June 2026
| Item | Until May 2026 | From June 2026 |
|---|---|---|
| First guidance | 800 points | 850 points (740 when using information and communication equipment) |
| Second and later | 400 points | 500 points (435 when using information and communication equipment) |
| Consultation support addition | 50 points | 400 points |
| Eligible patients | Patients with diseases designated by the Minister (malignant tumors, cerebrovascular disease, designated intractable diseases, chronic liver disease, heart disease, diabetes, early-onset dementia) | Disease designation abolished. Non-inpatients who need repeated, continuing treatment to prevent worsening and who need consideration to remain employed |
| Work-information document | "Work Information Form" jointly prepared by the patient and employer | Also accepted: the patient-prepared "Treatment and Work Balance Support Card" confirmed by the employer |
| Period for second and later guidance | Up to 3 months from the month of the first billing, once a month | Up to 6 months, once a month |
- Points, billing period and eligible patients are described consistently in both the MHLW revision overview and the Labour Standards Bureau notices.
- The revision applies from June 1, 2026.
Billing requirements in three steps
This fee is billed when the attending physician, having understood the patient's work situation, shares the information needed for balancing treatment and work with the occupational physician or equivalent at the patient's workplace. The MHLW guide (FY2026 edition, included in the Shizuoka Labour Bureau PDF cited below) divides the first-guidance requirements into three parts.
| Step | Content |
|---|---|
| ❶ Receive work information | Receive from the patient a document describing work information jointly prepared by the patient and employer (including a document prepared by the patient and confirmed by the employer). Forms: "Work Information Form" or "Support Card" |
| ❷ Give guidance | Based on ❶, give the patient medical and work-related guidance |
| ❸ Inform the occupational physician, etc. | Provide the information needed to balance work and treatment to the occupational physician or equivalent appointed at the patient's workplace. Form: "Attending Physician's Opinion" |
The second and later guidance (500 points) is billed once a month when, after providing the information, the physician checks the patient's work situation and gives necessary medical guidance (step ❹).
Who counts as an "occupational physician, etc."
The note in the MHLW overview lists the following under the Industrial Safety and Health Act:
- Occupational physician
- General safety and health manager
- Health manager
- Safety and health promoter / health promoter
- Public health nurse who manages workers' health
The guide also states that the recipient of the physician's information is the occupational physician or equivalent appointed at the patient's workplace. How a case is handled when the workplace has no such appointee cannot be confirmed from these materials. Check the circulars, Q&As or your regional bureau for individual cases.
How the billing period works
The overview states that for second and later guidance the limit is "6 months counted from the month of, or the month after, the first billing date". It was 3 months before the revision; it was extended to 6 months because actual treatment often continues beyond 3 months. Decide how your claims software tracks the count so that you neither miss nor exceed the period.
No separate charge for the document
The overview states that because the fee includes the creation of the document giving the occupational physician the information needed to balance work and treatment (including opinions on return to work requested by the occupational physician), the clinic may not separately charge for issuing that document as a service unrelated to insured care during the month in which the fee is billed. If your front desk quotes certificate or opinion fees, review how billing months are handled.
Consultation support addition (400 points): requirements and notification
The addition is billed when a nurse, social worker, psychiatric social worker or certified public psychologist provides consultation support. The guide describes it as a dedicated qualified staff member joining the guidance session to provide support.
Facility standards (circular Section 7-2)
Section 7-2 of the facility-standards circular for special medical treatment fees (Hoi-hatsu 0305 No. 8) states:
- A dedicated nurse, social worker, psychiatric social worker or certified public psychologist is assigned
- That staff member may also serve as the staff member specified for the patient support system enhancement addition
- That staff member has completed training, conducted by the national government or a medical association, that follows the training curriculum for work-treatment balance support coordinators set by the MHLW
Notification steps
- Notify using Form 8-3 of Attachment 2 (attachment to the notification for the consultation support addition).
- The form lists each eligible staff member (at least one): name, profession (nurse / social worker / psychiatric social worker / certified public psychologist) and whether training was completed.
- A document confirming training completion (a list stating the course name, organizer, completion date and name of the person is acceptable) must be attached.
- For guidance using information and communication equipment (Note 5), you only need to have notified your telemedicine arrangement; no separate notification for Note 5 is required. See also Getting Started with Online Medical Care.
For the timing of acceptance and how notifications after June 2026 are handled, check with your regional bureau of health and welfare.
What abolishing the disease designation means in practice
With the disease list gone, the entry point moves from "which diagnosis" to "is repeated, continuing treatment needed, and does the patient need consideration to stay employed". Conditions that were previously excluded may now be considered if they meet this test.
| Check | What to look at |
|---|---|
| Not an inpatient | Outpatients only (inpatients are excluded) |
| Repeated, continuing treatment | Whether ongoing outpatient treatment is in place |
| Consideration needed to remain employed | Whether work hours, duties or visit frequency need adjustment |
| Work-information document | Work Information Form, or a Support Card confirmed by the employer |
| Recipient of information | Whether the workplace has an appointed occupational physician or equivalent |
Note: Whether a given patient "needs consideration to remain employed" is a physician's judgment. This article does not state billing eligibility by diagnosis.
For ongoing chronic-disease management, see Lifestyle Disease Management Fee shift and Rethinking Diabetes Outpatient Billing by Workflow. For organizing multiple management fees in one visit, the comprehensive community care addition article is also useful.
In-house checklist
- The clinic shares who may qualify (outpatient, repeated treatment, consideration needed to remain employed)
- How work-information documents (Work Information Form / employer-confirmed Support Card) are received and stored is decided
- The procedure and owner for preparing the "Attending Physician's Opinion" are decided
- The 6-month limit for second and later guidance can be checked in the claims software
- Separate document fees are no longer charged in billing months
- If billing the consultation support addition, a dedicated qualified staff member is assigned and training-completion documents are ready
- The consultation support addition notification (Form 8-3) has been submitted
- This fee has been added to the missed-billing check
For operations that prevent missed billing, see also Why Billing Is Missed: A Cause-by-Cause Checklist.
FAQ
Q. Can we bill for patients whose conditions were not eligible before May 2026? A. The disease designation was abolished from June 2026. Eligible patients are non-inpatients who need repeated, continuing treatment to prevent worsening and who need consideration to remain employed. The physician judges eligibility, and the required documents must be exchanged.
Q. Can we bill with only a Support Card the patient wrote? A. A patient-prepared Support Card is accepted as the work-information document when it is provided to the medical institution after the employer's confirmation. A card without employer confirmation does not meet this requirement.
Q. Is notification required for the consultation support addition? A. The circular says Form 8-3 of Attachment 2 is used for notification of the facility standards for the addition. It requires a dedicated qualified staff member who has completed training following the work-treatment balance support coordinator curriculum.
Q. Can the staff member for the patient support system enhancement addition also provide this support? A. The circular states that the same person may serve in both roles.
Summary
- From June 2026 the fee is 850 points for the first guidance and 500 points for second and later guidance, and the consultation support addition rose from 50 to 400 points.
- The disease designation was abolished: outpatients who need repeated, continuing treatment and consideration to remain employed are eligible.
- Work information may be a Work Information Form or a Support Card confirmed by the employer. The period for second and later guidance extends to 6 months.
- The consultation support addition requires a dedicated qualified staff member, completion of training following the coordinator curriculum, and Form 8-3 notification.
Pottech provides an AI electronic medical record with billing and claims-checking functions for clinics. If you need help preventing missed billing for new or revised fees or reviewing billing history, please feel free to contact us.
References
- MHLW, "Overview of the FY2026 Medical Fee Revision," Ⅲ-1 Revision of the treatment-work balance support guidance fee and overview (reference) https://www.mhlw.go.jp/content/12400000/001681336.pdf
- MHLW Labour Standards Bureau, Occupational Health Division, "Revision of medical fees related to balancing treatment and work" (March 5, 2026, Ki-an-rou-hatsu 0305 Nos. 2 and 3) https://jsite.mhlw.go.jp/shizuoka-roudoukyoku/content/contents/002589855.pdf
- MHLW Health Insurance Bureau, "Handling of facility standards and notification procedures for special medical treatment fees" (March 5, 2026, Hoi-hatsu 0305 No. 8) (Section 7-2; Attachment 2 Form 8-3) https://kouseikyoku.mhlw.go.jp/kyushu/000476242.pdf