Remote Collaborative Care Fee of 900 Points Can Be Billed Even for DPC Patients

Even for inpatients whose hospitalization is reimbursed under DPC/PDPS, B005-11 “Remote Collaborative Care Fee, 3 Inpatient Care, 900 points” can be billed in the fee-for-service portion of a DPC claim, provided that all applicable billing requirements are met.

This conclusion can be established by examining, in sequence, the Medical Fee Schedule, the DPC Q&A, the Medical Procedure Master, and the Master File Specification.

1. A 900-Point Fee Is Explicitly Established for Inpatient Care

Under the FY2026 “Medical Fee Schedule, Appendix Table 1,” B005-11 Remote Collaborative Care Fee is divided into the following three categories:

B005-11 Remote Collaborative Care Fee

1 Outpatient care      900 points
2 Home-visit care      900 points
3 Inpatient care       900 points

Therefore, the fact that a patient is hospitalized does not itself prevent billing. In FY2026, “3 Inpatient Care” is explicitly established as a 900-point service.

Source

• Ministry of Health, Labour and Welfare, “Appendix Table 1: Medical Fee Schedule”
• FY2026 Medical Fee Revision_Medical Fee Schedule_Notification No. 69.pdf
• PDF p.126
• B005-11 “Remote Collaborative Care Fee”

2. Not All Medical Services Are Included in the DPC Bundled Payment

The next question is whether the 900-point Remote Collaborative Care Fee is absorbed into the bundled DPC payment when the patient is reimbursed under DPC/PDPS.

Under DPC, medical services are treated differently depending on whether they fall within or outside the bundled scope.

The FY2026 DPC Q&A states that, for patients hospitalized in a DPC ward, medical services outside the DPC bundled scope can be billed separately under the Medical Fee Schedule, while services within the bundled scope cannot be billed separately.

Therefore, to determine whether the Remote Collaborative Care Fee can be billed, it is necessary to establish whether B005-11 is treated as bundled or fee-for-service under DPC.

Source

• Ministry of Health, Labour and Welfare, “Questions and Answers Regarding the FY2026 Medical Fee Revision (No. 2)”
• FY2026 Medical Fee Revision_Q&A_No.2.pdf
• PDF pp.71–72
• “11. Handling of Consultations and Visits to Other Medical Institutions”
• Questions 11-2 and 11-3

3. Confirming B005-11 in the Medical Procedure Master

The FY2026 Medical Procedure Master published by the Ministry of Health, Labour and Welfare contains the following record corresponding to B005-11 “3 Inpatient Care”:

Field	Value
Medical procedure code	113715010
Name	Remote Collaborative Care Fee (Inpatient Care)
Points	900 points
Fee schedule code	B 2-01-005-11-003
DPC applicability code	1

The fee schedule code B 2-01-005-11-003 corresponds to B005-11, item 003, namely “3 Inpatient Care.”

The key field here is the DPC applicability code 1.

Source

• Ministry of Health, Labour and Welfare, “FY2026 Medical Procedure Master”
• File: s_20260731.csv
• Medical procedure code: 113715010
• “Remote Collaborative Care Fee (Inpatient Care)”

4. DPC Applicability Code “1” Means Fee-for-Service Billing Is Permitted

The numeric DPC applicability code must then be interpreted using the Ministry’s “FY2026 Master File Specification.”

For item 18, “DPC Applicability,” the Medical Procedure Master defines the main values as follows:

DPC Applicability Code	Meaning
0	Medical procedure included in the points specified in the DPC fee schedule (bundled payment)
1	Medical procedure that can be billed in the fee-for-service portion of a DPC claim

The DPC applicability code for B005-11 “Remote Collaborative Care Fee (Inpatient Care)” is 1.

Therefore, the 900-point fee is not included in the DPC bundled portion. It is a medical service that can be billed in the fee-for-service portion of a DPC claim.

Decision Logic

In other words:

A patient being billed under DPC does not make the Remote Collaborative Care Fee non-billable.

B005-11 “Remote Collaborative Care Fee (Inpatient Care)” has a DPC applicability code of 1, which officially means that the service can be billed in the fee-for-service portion of a DPC claim.

However, DPC applicability code 1 does not by itself mean that all requirements for the 900-point fee have been satisfied.

For inpatient care, B005-11 has its own billing requirements, including patient eligibility, facility requirements, patient consent, prior provision of clinical information, and collaborative care using information and communication technology with a physician at another medical institution providing specialized care. The fee may also be billed only once every three months.

The final interpretation is therefore:

Even for a patient reimbursed under DPC, B005-11 has a DPC applicability code of 1, meaning that it can be billed in the fee-for-service portion of a DPC claim. The 900-point fee can then be billed if all specific requirements for B005-11 “3 Inpatient Care” are satisfied.

References

1. Ministry of Health, Labour and Welfare, “Appendix Table 1: Medical Fee Schedule”

   • Establishes B005-11 “Remote Collaborative Care Fee” and “3 Inpatient Care, 900 points.”
   • https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00074.html

2. Ministry of Health, Labour and Welfare, “Questions and Answers Regarding the FY2026 Medical Fee Revision (No. 2)”

   • Confirms that medical services outside the DPC bundled scope can be billed separately, whereas services within the bundled scope cannot.
   • https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000188411_00074.html

3. Ministry of Health, Labour and Welfare, Medical Fee Information Service, “FY2026 Medical Fee Revision”

   • Publishes the FY2026 Medical Procedure Master.
   • https://shinryohoshu.mhlw.go.jp/shinryohoshu/kaitei/

4. Ministry of Health, Labour and Welfare, “FY2026 Medical Procedure Master”

   • Records procedure code 113715010, “Remote Collaborative Care Fee (Inpatient Care),” at 900 points with DPC applicability code 1.
   • https://shinryohoshu.mhlw.go.jp/shinryohoshu/downloadMenu/sFile

5. Ministry of Health, Labour and Welfare, “FY2026 Master File Specification”

   • Defines item 18, “DPC Applicability,” and specifies code 1 as “a medical procedure that can be billed in the fee-for-service portion of a DPC claim.”
   • https://shinryohoshu.mhlw.go.jp/shinryohoshu/file/spec/R08rec1.pdf

6. Ministry of Health, Labour and Welfare, “FY2026 Master File Specification — File Layout”

   • Defines the field structure of the Medical Procedure Master and the position of the DPC applicability field.
   • https://shinryohoshu.mhlw.go.jp/shinryohoshu/file/spec/R08rec3.pdf