Healthcare
Tax advisor for physiotherapists
Prescription, self-paying patients, training: we sort every item of revenue onto the right tax track. In your practice, a single sheet of paper decides the VAT (Umsatzsteuer) treatment: the medical prescription (Verordnung). Whatever runs on a prescription is tax-exempt; whatever comes afterwards (follow-up treatments, services for self-paying patients, training) needs a deliberate tax classification. We give physiotherapy practices a system that assigns every service to the right track automatically, safeguards freelance professional status (freiberuflich) despite a growing team, and delivers reports that let you calculate positions, floor space and courses honestly.
Key focus areas for physiotherapists
- VAT (Umsatzsteuer): medical treatment on a doctor's prescription (Verordnung) is exempt; keep an eye on self-paying patient (Selbstzahler), wellness and prevention offerings
- Staying a freelance professional (freiberuflich) despite employed therapists: securing a managing and personally responsible role
- Equipment-based training, courses and product sales: separating commercial areas cleanly and avoiding cross-contamination of all income (Abfärbung)
- Billing with statutory health insurers (Krankenkassen) and private patients in the cash-basis profit and loss statement (EÜR)
- Investments in practice equipment and training machines: depreciation and financing
The prescription has run out, the treatment has not
You know the situation: the medical prescription (Verordnung) has been worked through, the patient wants to continue, and the new prescription is slow in coming. Professionally a matter of course, in tax terms a turning point. The VAT exemption for your medical treatment depends on a documented therapeutic purpose, and the tax authorities generally see that evidence in the doctor's prescription. Follow-up treatments without a new prescription are therefore normally treated as taxable. Anyone who books everything here as tax-exempt for years builds up a silent risk. We define with you which services run on which basis, and how you can structure the transition to self-paying patient (Selbstzahler) status cleanly.
Wellness, prevention, equipment training: the second track
Massages without a prescription, prevention courses under § 20 SGB V, equipment-based training on a subscription: these offerings strengthen your practice. As a rule, though, they are not tax-exempt, because the direct link to an illness is missing. That is no reason to drop them, but a reason to calculate them correctly: with VAT (Umsatzsteuer) in the price and separate recording. And once the training becomes a business line of its own within your GbR, cross-contamination of all income (Abfärbung) is waiting in the background: above narrow de minimis thresholds, a single commercial activity makes the entire partnership liable to trade tax (Gewerbesteuer). We keep both levels in view at the same time.
Growing with a team, staying freelance
Employed therapists are the normal route to more capacity. Freelance professional status (freiberuflich) is only preserved if you, as the owner, shape every treatment professionally: assessment, treatment plan, progress monitoring. Pure organisation is not enough for the courts. We show you how to document your professional imprint and delegation, and we work through what hiring staff, a second floor space or specialisation would mean for your figures. So that the separation does not remain theory, we anchor it in your bookkeeping: separate revenue accounts for each track, advance VAT returns only for the taxable part and, often overlooked, the proportionate input VAT, because with mixed turnover the input VAT deduction has to be apportioned. On top of that come reports in the rhythm of the prescription cycle: what does a single treatment session really bring in after all costs, how is the self-payer share developing, from what point does the next position pay for itself? That way you ultimately manage your practice with figures that match the reality at the treatment table.
Traffic-light logic
- Green, tax-exempt: treatment on a doctor's or alternative practitioner's prescription (Verordnung) with a therapeutic aim
- Amber, needs checking: self-payer and follow-up treatments without a new prescription (evidence required!)
- Red, taxable: wellness massages, general prevention, fitness and equipment-based training
An example from our advisory work
Hypothetical example: a practice with four employed therapists opens a training area with a subscription model. Challenge: the training is taxable and can cross-contaminate income within the GbR; at the same time, the owner has to keep shaping the treatments professionally. Suitable service: separate revenue structure, monitoring for cross-contamination (Abfärbung), organisation of case responsibility. Intended benefit: additional revenue without trade tax (Gewerbesteuer) on the therapy work. Next step: an initial consultation including floor-space and revenue planning.
Frequently asked questions
In the view of the tax authorities, generally not: for the health professions the medical prescription (Verordnung) counts as the central evidence of therapeutic purpose, so continued treatment after the prescription has run out, without a new one, is regularly classified as taxable. The courts do allow other medical evidence as well; anyone wishing to rely on that, however, needs robust documentation. The safe route remains the follow-up prescription.
As a stand-alone offering (training area, subscription, open courses) it is taxable, because the link to a specific illness is missing. Training can only be tax-exempt if it is demonstrably part of an individual medical treatment, for example as a measure accompanying a prescription within the treatment plan. Calculate the training area gross for that reason, record it separately and, within a GbR, keep an eye on the cross-contamination (Abfärbung) thresholds.
Yes, subject to one condition that the courts apply strictly: you have to shape every treatment professionally, which means visibly taking personal responsibility for assessment, treatment planning and progress monitoring. Organisation, duty rosters and spot checks are not enough; otherwise commercial income and trade tax (Gewerbesteuer) loom. Documented case responsibility, clear supervision rhythms and realistic patient numbers per owner are the practical levers we set up with you.
Even where the health insurer contributes: prevention courses under § 20 SGB V are regularly subject to VAT (Umsatzsteuer), because the link to a specific illness is missing. They stay tax-exempt only by way of exception, where they are demonstrably part of an individual medical treatment or preventive care. Calculate courses gross from the outset, therefore, and record the revenue separately from prescribed therapy. We review your course programme once in full and put the classification on file in writing.
Often yes: the scheme only concerns your taxable turnover, meaning self-payer services without therapeutic evidence, wellness and training. If these stay below the statutory thresholds, you can dispense with showing tax on invoices and save yourself advance returns; the figures do change, however, and have to be checked against the current rules. Whether waiving is worthwhile also depends on your investments, because it costs you the input VAT deduction for that area. We work through both variants for your practice.
With physiotherapy practices, a brief overview of the prescription and self-payer shares helps. For an initial assessment, a few things are enough: the most recent business management report or the latest tax assessment, an overview of your service areas and, if available, your current chart of accounts. To take over ongoing support, you will receive a short checklist from us; powers of attorney and data access we set up together. You do not have to lug paper folders 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 on site, as you prefer. This means support is not tied to the firm's location; what matters is sector knowledge, not the postcode. How short check-ins between two treatments work best is something we determine together; which tools are used in concrete terms is something we adapt to your practice workflows during setup.
With physiotherapy practices, team size and the self-payer area help determine the framework. The fees follow the German tax advisor fee regulation (Steuerberatervergütungsverordnung) and depend on the values at issue, the scope of services and the effort involved; flat-fee agreements are possible for ongoing services. You will receive a solid quote after the initial consultation; for that, the latest report, the number of documents and the modules you want are enough. We do not consider imaginary fixed prices without a look at your practice to be reputable.
Your next step
How much of a self-payer share can your practice sustain? Let us work it through in the initial consultation. After your enquiry you will receive an acknowledgement of receipt; your dedicated contact person will then get in touch. Still getting your bearings? We answer the most common questions directly above on this page.