Japanese dermatology clinics (皮膚科, hifuka) work under two payment systems. Insurance-covered care (保険診療, hoken shinryo) is for diagnosing and treating disease: eczema and atopic dermatitis, contact dermatitis, acne, hives, fungal infections, warts, cold sores and shingles, psoriasis, and the surgical removal of a mole or cyst that needs it. Prices are set by the national fee schedule, in which one point equals ¥10, so the same visit costs about the same at any clinic. Self-pay care (自由診療, jiyu shinryo) covers everything cosmetic, such as laser hair removal, pigmentation lasers, Botox, fillers, peels, and HIFU, and each clinic sets its own prices.
Many clinics offer both and keep them apart. Under the insurance rules published by the Ministry of Health, Labour and Welfare, a clinic may not bill an uninsured treatment together with the patient's share of insured care for the same course of treatment (so-called mixed care, 混合診療), except in specific cases the government designates. In practice, clinics often use separate booking slots: Meguro Dermatology Clinic books its full-body mole check in the cosmetic counseling slot, and Shibuya International Skin Clinic takes aesthetic treatments by phone only, not through its online booking system. Some services sit on the self-pay side even though a dermatologist provides them: Takadanobaba Dermatology & Plastic Surgery states that a total body skin check is not covered by insurance if you want three or more moles or lesions examined, and it lists male and female pattern hair loss under cosmetic medicine. Shinagawa Suzuki Dermatology Clinic notes that removing a suspicious mole by excision is covered, while removing a mole by laser is self-pay.
Clinics that do not take Japanese insurance work differently. Tokyo Skin Clinic in Roppongi states that it provides dermatology for expatriates "free from the constraints of Japanese public health insurances", charges by consultation time, and dispenses medication in the clinic. Cosmetic-focused clinics such as Omotesando Rejuva Medical Clinic, Art Lounge Clinic, and Tokyo Ginza Medical Clinic are self-pay only.