Japan Reimbursement for AI Echocardiography
Coding and reimbursement pathways in Japan for echocardiography under the National Health Insurance (NHI) fee schedule administered by MHLW. All procedures are priced in points, with 1 point = ¥10.
Reimbursement Landscape in Japan
Echocardiography in Japan is reimbursed under the National Health Insurance fee schedule (Iryo Hoken Tensū-hyō) published by MHLW. The schedule is revised on a two-year cycle. All medical procedures are priced in points (1 point = ¥10); echocardiography sits in the D215 family under diagnostic ultrasound.
NHI Universal Coverage
Japan operates universal coverage through employer-based health insurance (Kenpo), national health insurance (Kokuho), and elder care (Koki Koreisha). All cover echocardiography under the same NHI fee schedule with patient co-payments of 10–30%.
Point-Based Pricing
All NHI procedures are priced in points where 1 point = ¥10. Cardiac ultrasound sits under D215「3」心臓超音波検査 with sub-classifications for TTE (880 pts), M-mode (500 pts), TEE (1,500 pts), fetal echo (300 pts), and stress echo (2,010 pts). The Reiwa 6 (2024–2026) schedule is the current basis; the next biennial revision applies in April 2026.
DPC for Inpatients
Inpatient hospital activity is reimbursed under the DPC (Diagnosis Procedure Combination) per-diem case-mix system at participating hospitals. Echocardiography during a DPC admission is bundled within the case payment rather than separately tariffed.
Relevant NHI Codes
Echocardiography codes under D215「3」(心臓超音波検査) in the Reiwa 6 (2024–2026) NHI fee schedule. 1 point = ¥10.
Transthoracic Echo (TTE)
経胸壁心エコー法. Standard transthoracic echocardiography of the heart.
Point value: <strong>880 points (¥8,800)</strong>. The workhorse cardiac ultrasound code in Japan. Reported once per study. AI-assisted measurement and reporting supports the cardiologist's interpretation within this code.
M-mode (Mモード法)
Mモード法. M-mode cardiac ultrasound for chamber dimension and timing.
Point value: <strong>500 points (¥5,000)</strong>. Reported when the study is principally M-mode rather than 2D TTE.
Transoesophageal Echo (TEE)
経食道心エコー法. Transoesophageal echocardiography.
Point value: <strong>1,500 points (¥15,000)</strong>. Reported by cardiologists or anaesthesiologists for valvular and intra-cardiac assessment.
Stress Echocardiography
負荷心エコー法. Stress echocardiography (exercise or pharmacologic).
Point value: <strong>2,010 points (¥20,100)</strong>. Covers both exercise and pharmacologic stress under specific clinical indication rules. AI-assisted strain and EF support pre- and peak-stress interpretation.
Fetal Echocardiography
胎児心エコー法. Fetal cardiac echocardiography; limited to once per month per the告示.
Point value: <strong>300 points (¥3,000)</strong>, plus a <strong>胎児心エコー法診断加算 +1,000 points (¥10,000)</strong> when diagnostic-grade reporting criteria are met. Specific physician qualifications apply.
Common Add-ons (加算)
Add-on codes reported in addition to the base D215「3」cardiac ultrasound code when applicable.
<strong>パルスドプラ法加算 +150 pts (¥1,500)</strong> when PW Doppler is performed. <strong>造影剤使用加算 +180 pts (¥1,800)</strong> when an ultrasound contrast agent is administered. These are layered on top of the base study code rather than billed standalone.
Point values reflect the Reiwa 6 (2024–2026) NHI fee schedule; the next biennial revision applies April 2026. Co-payment varies 10–30% by patient category; high-cost care (高額療養費 / kogaku ryōyō-hi) caps out-of-pocket per month. DPC inpatient admissions bundle echo within the case payment rather than billing D215「3」separately. Verify against the live MHLW告示.
Model the impact on your service
Enter your annual echo volume and NHI point context to estimate net new capacity from AI-assisted reporting.
Reimbursement by Care Setting
Payment routes in Japan differ between outpatient clinics under fee-for-service NHI, hospital outpatient, and DPC inpatient.
Clinic Outpatient
Private cardiology clinics (shinryō-jo) and outpatient departments bill the NHI schedule directly per encounter. Patients pay 10–30% co-payment.
High-volume echo clinics benefit from AI-assisted throughput; per-study revenue is fixed by the NHI schedule.
DPC Hospital Inpatient
Participating large hospitals reimburse inpatient stays under the DPC per-diem case-mix system. Echo during a DPC admission is bundled into the case payment.
AI-assisted reporting in DPC inpatients supports cardiology throughput and shorter length of stay rather than direct additional reimbursement.
Non-DPC Hospital
Smaller hospitals not participating in DPC bill NHI fee-for-service for echo studies, the same way as outpatient clinics.
Japanese Procurement & Regulatory Context
AI echocardiography software in Japanese hospitals is assessed against PMDA approval, APPI data protection, and increasingly the SaMD framework.
PMDA Approval
Software classified as a medical device requires PMDA approval (shōnin) under the PMD Act. Us2.ai is PMDA-approved as a Class II medical device.
APPI & Data Residency
The Act on Protection of Personal Information (APPI) governs medical data handling. Japanese-region cloud hosting is supported, and on-premise deployment is available for hospitals with stricter requirements.
SaMD Reimbursement Track
MHLW has developed dedicated reimbursement pathways for software medical devices (SaMD), with several AI-enabled tools receiving NHI category designations. The pathway is evolving and product-specific.
Frequently Asked Questions
Common questions about echocardiography coding and reimbursement in Japan.
What is the NHI fee schedule and how does it pay for echo?
How does DPC affect inpatient echo billing?
What patient co-payment applies?
Is Us2.ai PMDA-approved?
Does Japan have a Category III equivalent for AI echo?
How is patient data handled under APPI?
How often does the NHI schedule change?
Where can I get Japan-specific reimbursement guidance?
Important Information
Information is provided for general informational purposes only and is not a guarantee of coverage or reimbursement. NHI point values, DPC case categories, and SaMD-track designations are subject to change. Providers should verify against the current MHLW schedule. The NHI fee schedule is published by MHLW.
Questions about Japan Reimbursement?
Our team can support business cases for outpatient cardiology clinics, DPC hospitals, and academic centres with current NHI fee schedule context, PMDA documentation, and clinical evidence.
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