Healthcare
Tax advisor for occupational therapists
Is your practice growing beyond you? We make sure the taxes grow with it, not against it. Occupational therapy practices grow through people: more therapists, more cooperations, more medical prescriptions (Verordnung). We make sure the taxes do not stand in the way of that growth: with an organisation that documents your professional imprint on every treatment, classifies cooperation fees correctly and keeps additional services such as courses or material sales on the right tax track. Plus planning calculations that turn ideas into decisions you can rely on.
Key areas for occupational therapists
- VAT (Umsatzsteuer): prescribed occupational therapy is exempt; classifying self-pay and preventive health services correctly
- Freelance professional status (freiberuflich) despite a practice team: treatment under your own responsibility as the condition
- Therapy materials and practice equipment: business expenses and depreciation
- Home visits and cooperations with institutions: recording travel costs and fees correctly
- Setting up and taking over a practice: from investment planning to the choice of legal form
Growing without losing freelance professional status
Occupational therapy practices almost always grow through the team: more therapists, more rooms, more medical prescriptions (Verordnung). In tax terms, an inconspicuous formula decides a great deal of money: "in a leading capacity and under your own responsibility". Only if you as the practice owner give every treatment your professional imprint, from the assessment through the therapy plan to the progress review, does your income remain that of a freelance professional (freiberuflich) and exempt from trade tax (Gewerbesteuer). Delegation is expressly permitted; becoming invisible is not. We turn this formula from case law into practice organisation that is actually lived: documented case responsibility, clear supervision rhythms, clean allocation in the accounts.
Prescribed therapy exempt, the edges in view
Prescribed occupational therapy is exempt from VAT (Umsatzsteuer) as medical treatment; as a recognised healthcare profession you meet the professional qualification requirement. It becomes taxable wherever the individual link to an illness is missing: preventive health services, concentration training offered as open courses, consulting packages for institutions or the sale of therapy materials. Such services are valuable for your positioning; they simply need the right track in costing and bookkeeping. In a joint practice, the cross-contamination of all income (Abfärbung) is added to this: commercial secondary turnover above the de-minimis thresholds (Bagatellgrenze) makes the entire partnership liable to trade tax (Gewerbesteuer). We keep an eye on the thresholds and restructure before it becomes expensive.
From concept to a reliable figure
Whether it is a start-up, a takeover or a specialisation in paediatrics, neurology or hand therapy: every strategic idea needs a figure to carry it. We provide planning calculations for investments and staff, accompany financing discussions and set up your reports so that you can see, for each service area, what it really contributes. That turns "we could do that some time..." into "from the third quarter it pays off". Cooperations are a chapter of their own: fees from day-care centres, schools or care facilities can be medical treatment, or they can be consulting and training services, which are taxable. The difference lies solely in the contract and in the documentation that is actually kept, not in the good intentions of everyone involved. That is why we write the tax perspective into your cooperation agreements from the start and record travel and journey times for what they are: business expenses and a costing factor. That way the practice and the network grow together without the tax side lagging behind, and you know at any time which contract really carries itself at the end of the year.
A typical pitfall
Preventive courses under § 20 SGB V look like "financed by the health insurer = tax exempt", but as a rule they are not: without an individual link to an illness, VAT (Umsatzsteuer) liability remains. Courses should therefore be costed on a gross basis from the outset.
Example from our advisory practice
Hypothetical example: an occupational therapy practice signs a cooperation agreement with a care facility and starts an open concentration training course. Challenge: the fee from the facility can be medical treatment or a taxable training service; without a medical prescription (Verordnung) the course is taxable. Suitable service: a tax review of the contract plus separate recording of revenue. Intended benefit: a clear classification before the first invoice. Next step: an initial consultation with a draft contract.
Frequently asked questions
As a rule no: courses under § 20 SGB V aim at general health promotion, not at treating a specific illness; the health insurer's subsidy does not change that. A course is only exempt if it is demonstrably part of an individual medical treatment or precautionary care. Plan open courses from the outset with VAT (Umsatzsteuer) included in the price and with separate recording of revenue.
Selling exercise materials, everyday aids or work tools is trading: subject to VAT (Umsatzsteuer) and commercial for income tax purposes. In a single-owner practice, separate recording is enough; in a joint practice the scale becomes a decisive question, because commercial turnover above the de-minimis threshold (Bagatellgrenze) contaminates all income. Small ranges are uncritical; a growing shop should be put to the test and, if necessary, moved into a separate entity.
Yes, as long as the professional signature of the owner recognisably shapes every treatment: your own assessment, therapy planning and regular progress reviews for every client. Case law expressly accepts delegation, but not the mere organisation of a team of therapists. In practice, documented case responsibility and fixed supervision structures secure freelance professional status (freiberuflich); we build both into your workflows and record them in a verifiable way.
That does not depend on the size of the group but on the basis: prescribed group therapy with an individual therapeutic goal remains exempt. Open services without a medical prescription (Verordnung), such as concentration or relaxation courses and general prevention, are as a rule taxable, even if health insurers provide a subsidy. What matters is that you plan, cost and invoice the two formats separately. We set out the classification of your course programme in writing so that every new group automatically runs correctly.
Selling materials (exercise equipment, everyday aids, worksheets) is trading and therefore commercial as well as subject to VAT (Umsatzsteuer); it belongs in separate revenue accounts. In a single-owner practice this stays manageable, in a joint practice it becomes important: if sales turnover exceeds the de-minimis threshold (Bagatellgrenze) of 3 % of total turnover or 24.500 € per year, it contaminates the entire partnership. We monitor this threshold on an ongoing basis and examine alternatives such as outsourcing the sales side in good time.
With occupational therapy practices we are happy to look at existing cooperation agreements straight away. A few things are enough for an initial assessment: the most recent business analysis (betriebswirtschaftliche Auswertung) or the latest tax assessment notice, an overview of your service areas and, if available, your current account overview. To take over ongoing support you will receive a short checklist from us; we set up powers of attorney and data access together. You do not have to carry paper files around: you can submit all documents digitally.
Yes. You submit receipts digitally, you receive reports electronically, and we hold meetings by video, by telephone or in person, as you prefer. This means that support is not tied to the office location; what matters is knowledge of the sector, not the postcode. How sites and cooperation partners are involved in the coordination and which tools are used specifically is something we clarify together with you at the start.
With occupational therapy practices, cooperations and course offerings feed into the estimate of the work involved. Remuneration follows the German tax advisor fee regulation (Steuerberatervergütungsverordnung) and depends on the values of the matters (Gegenstandswert), the scope of services and the workload; flat-rate agreements are possible for ongoing services. You will receive a reliable quote after the initial consultation; the most recent report, the number of documents and the modules you want are enough for that. We do not consider imaginary fixed prices without a look at your practice to be serious.
Your next step
Are you planning your next growth step? We will work through the figures with you in the initial consultation. After your enquiry you will receive a confirmation of receipt; your permanent contact person will then get in touch. Still weighing things up? We answer the most common questions directly at the top of this page.