Healthcare
Tax advisor for speech and language therapists
Prescription, health insurance fund, home visit: we keep your practice's figures as clear as you keep your patients' language. Your therapy takes effect in the practice, the day care centre and the nursing home; for tax purposes it is not the place that counts, but the prescription. We support speech therapy practices from start-up through to a growing team: with bookkeeping that automatically separates prescribed therapy, courses and lectures, with complete recording of your home visit journeys, and with analyses that show which part of your week actually carries the practice.
Key areas for speech and language therapists
- VAT-exempt (Umsatzsteuer) speech therapy on a medical prescription (Verordnung); distinguishing it from courses, lectures and advisory services
- Securing income with freelance professional status (freiberuflich), including with employed speech and language therapists
- Reflecting health insurance and private billing correctly in your bookkeeping
- Home visits to day care centres, schools and care facilities: claiming travel and journey costs correctly
- Practice start-up and takeover: investments, financing and legal form
Between the prescription and day care co-operation
Your working day rarely takes place in the treatment room alone: home visits to day care centres, schools and care facilities, coordination with the prescribing doctors, billing via the health insurance funds. For tax purposes this routine is well regulated, as long as the prescription remains at the centre of it. Prescribed speech therapy is exempt from VAT (Umsatzsteuer) as medical treatment; speech and language therapists are recognised as members of a health profession for this purpose. It becomes delicate at the margins: parents' evenings and training sessions, language development courses without an individual prescription, or advisory packages for institutions are not medical treatment and are therefore generally taxable. We classify your full range of services once; after that, the separation runs by itself in your bookkeeping.
Freelance professional status, also as a "similar profession"
For income tax purposes you belong to the allied health professions (Heilhilfsberuf) that are treated as equivalent to the listed profession of physiotherapist (Krankengymnast); the licence under § 124 SGB V is the decisive indication of this. That secures you the lean cash-basis profit and loss statement (EÜR) and exemption from trade tax (Gewerbesteuer). As the team grows, however, the same rule applies as in all therapeutic practices: the practice owner must shape every treatment professionally, from the initial assessment through therapy planning to progress monitoring. Anyone who in practice leaves patients entirely to their employees risks being reclassified as a commercial business. We help you organise and document this professional involvement and delegation so that growth does not turn into a tax question.
Practice figures that carry decisions
Is a second location worth it? Does the part-time position pay for itself? What does a day of home visits really cost? We translate your health insurance and private billing into analyses that answer such questions, including travel costs, staff and premises costs. We accompany start-ups and takeovers from the financing to the first advance VAT return (Voranmeldung). We also keep the side issues in mind: journeys to home visits in day care centres and institutions are business expenses and need to be recorded in full; anyone teaching part-time at a school for speech therapy usually operates in the freelance professional area, and with privileged institutions the instructor tax allowance (Übungsleiterfreibetrag) is available on top. Details like these regularly decide quite noticeable amounts at the end of the year. Our principle stays the same here: we build the right record-keeping into your working day instead of handing you lists. Your time belongs to your patients, not to the paperwork in the filing cabinet.
Three records that count
- The prescription (Verordnung): the most important evidence of the therapeutic purpose
- The diagnosis and progress documentation: it carries borderline cases too
- The licence under § 124 SGB V: an indication of a health profession and of freelance professional status (freiberuflich)
Example from our advisory practice
Hypothetical example: a speech and language therapist treats patients in day care centres on two days and hires her first employee. Challenge: recording journeys and travel times in full and securing freelance professional status (freiberuflich) despite delegation. Suitable service: digital receipt processes plus documented case responsibility. Intended benefit: no lost business expenses, no trade tax (Gewerbesteuer) discussion. Next step: an initial consultation with the weekly schedule and the job profile.
Frequently asked questions
Not all of them, but the core is: prescribed speech therapy is exempt as medical treatment, regardless of whether it takes place in your practice, in the day care centre or in the nursing home. Services without an individual treatment mandate, by contrast, are taxable: language development courses, lectures, training sessions for childcare staff or advisory packages for institutions. This second group should be calculated and invoiced separately; then the tax-exempt core stays stable.
Caution is advisable here: without a medical prescription (Verordnung) the usual evidence of the therapeutic purpose is missing, and in case of doubt the tax authorities classify such services as taxable. The exemption remains possible if the diagnosis, findings and treatment goal are documented on a patient-specific basis. Also check whether a follow-up prescription is obtainable; it is the simplest way to secure self-paid sessions for tax purposes.
The employment itself changes nothing, what matters is your role: if you remain the professionally decisive authority for every treatment, from the initial diagnosis to progress monitoring, the income keeps its freelance professional status. If, on the other hand, you effectively leave the patients entirely to the team, the classification tips over into a commercial business. We help you organise and document responsibilities so that growth and freelance professional status fit together.
Yes. For the VAT exemption (Umsatzsteuer) what matters is not where you treat, but that a prescribed therapy with a therapeutic aim exists and that you hold the professional qualification. Home visits to day care centres, schools or care facilities are therefore just as privileged as treatment on your own premises. The situation is different for language development courses or advisory packages for the institution itself: without an individual prescription these are regularly taxable services that should be invoiced separately.
As a rule no: speech and language therapists are treated as a health profession similar to the listed professions and earn income as freelance professionals (freiberuflich); the licence under § 124 SGB V is the decisive indication of this. Trade tax (Gewerbesteuer) becomes a risk in two constellations: if you effectively leave the treatments entirely to employed staff instead of shaping each one professionally, or if in a joint practice commercial secondary turnover grows beyond the de-minimis thresholds (Bagatellgrenze). Both can be organised; we will show you how.
For speech therapy practices, an overview of the most recent health insurance billing is sufficient in addition. A few things are enough for the initial assessment: the latest business analysis (BWA) or the latest tax assessment notice (Steuerbescheid), an overview of your service areas and, if available, the current list of accounts. To take over your ongoing support, you will receive a short checklist from us; we set up the powers of attorney and the data access together. You do not have to lug paper files around: you can submit all documents digitally.
Yes. You submit receipts digitally, you receive analyses electronically, and we hold meetings by video, by telephone or in person, as you prefer. This means the support is not tied to the location of the firm; what matters is knowledge of the sector, not the postcode. How days of home visits can be documented while on the road, and which tools are used specifically, is something we discuss together with you during the setup.
For single-therapist speech therapy practices we deliberately keep the entry point lean. The fees follow the German tax advisor fee regulation (Steuerberatervergütungsverordnung) and depend on the value of the matter (Gegenstandswert), the scope of services and the effort involved; flat-rate agreements are possible for ongoing services. You will receive a reliable quote after the initial consultation; for that, the latest analysis, the number of documents and the desired service modules are sufficient. We do not consider imaginary fixed prices without a look at your practice to be serious.
Your next step
Start-up, takeover or growth: tell us about your practice in an initial consultation. After your enquiry you will receive a confirmation of receipt; your dedicated contact person will then get in touch. Still finding your bearings? We answer the most frequent questions directly above on this page.