Healthcare
Tax Advisor for Podiatrists
One treatment chair, two tax worlds: we separate medical from cosmetic in a way that holds up and works in daily practice. Medically indicated treatment is exempt, cosmetic foot care is taxable: in podiatry this line runs right through the appointment calendar. We turn it into a system instead of a permanent building site: appointment types, the till and the accounts separate the areas automatically, the documentation also covers treatments without a prescription, and your returns, from the cash-basis profit and loss statement (EÜR) to VAT (Umsatzsteuer), come from a single source.
Focus areas for podiatrists
- VAT (Umsatzsteuer): medically indicated podiatric treatments are exempt, cosmetic foot care is taxable
- Proof of the therapeutic purpose: a medical prescription (Verordnung) and clean documentation
- Freelance professional status (freiberuflich) and commercial at the same time: separate records for treatment, foot care and product sales
- Podiatric therapy on prescription (Rezept), e.g. for diabetic foot syndrome: health insurance billing (Kassenabrechnung) and bookkeeping
- Small-business scheme (Kleinunternehmerregelung) and correct invoicing
One chair, two tax worlds
In hardly any practice do exempt and taxable sit as close together as in podiatry: often in the same treatment chair, on the same morning, with the same customer. Medically indicated podiatric treatment, for instance for diabetic foot syndrome, is exempt from VAT as medical treatment. Cosmetic foot care expressly is not. What decides the matter is never the label on the flyer, but the specific service on the specific foot: is there an underlying illness or health disorder, or is it care and wellbeing? We build this distinction into appointment types, till receipts and bookkeeping, so that the allocation happens automatically in daily practice.
The proof: the prescription is king, but not the sole ruler
The medical prescription, whether statutory or private, is the safest evidence of the therapeutic purpose; a mere "recommendation" is not enough for the tax authorities (Finanzverwaltung). The case law is a step more generous: exemption can also succeed without a prescription if the medical indication is documented on a patient-by-patient basis. That is exactly where a lot of money is decided in a tax audit (Betriebsprüfung). Together with you we define a documentation standard that runs alongside the treatment process without extra effort: findings, indication, treatment goal. Three lines that make the difference years later.
Freelance with the podiatry state examination, commercial at the shelf
Since the Podiatry Act (Podologengesetz), podiatrists have been treated as an allied health profession with freelance professional status (freiberuflich); the state examination also carries the qualification for VAT purposes. The cosmetic area and the sale of care products remain separate from this: they are commercial in character and belong in their own accounts, and in a joint practice they additionally call for monitoring the thresholds for cross-contamination of all income (Abfärbung). We keep the areas apart and your returns together: cash-basis profit and loss statement (EÜR), VAT (Umsatzsteuer), where applicable the small-business scheme (Kleinunternehmerregelung), with thresholds checked as at the current date. That leaves the framework: investments in the treatment chair, instrument reprocessing and hygiene are spread over the years in a plannable way through depreciation, and your invoices take the correct form for each area: without a VAT statement for medical treatment, with a statement for cosmetics and sales. Step by step this creates a system that is prepared for queries from the tax authorities and holds nobody up in daily practice: you treat your patients' feet, we treat the figures behind them.
Separation checklist
- Distinguish appointment types "medical" / "cosmetic" already in the calendar
- File prescriptions (Rezept), document the indication in three lines where there is no prescription
- Separate product groups at the till: treatment, foot care, product sales
- Separate revenue accounts: the basis for VAT and profit determination
Example from our advisory practice
Hypothetical example: a podiatrist treats prescription patients with diabetic foot syndrome in the mornings and offers cosmetic foot care in the afternoons. Challenge: identical rooms, identical instruments, but two tax worlds with documentation duties. Suitable service: a separation system made up of appointment types, till product groups and three-line documentation. Intended benefit: a well documented exemption for the medical area. Next step: an initial consultation with the current service catalogue.
Frequently asked questions
Exempt is medically indicated podiatric treatment, for instance for diabetic foot syndrome or other illness-related complaints. Cosmetic foot care for wellbeing or for the care of healthy feet, by contrast, is expressly taxable. Because both services often take place in the same chair, it is the classification of the individual appointment that decides: the indication and the treatment goal should therefore be documented briefly, and the revenue recorded separately.
Yes, that is possible: the case law does not require a prescription as the only means of proof; other medical findings can also evidence the therapeutic purpose. In practical terms this means: without a prescription (Verordnung) you document the findings, the underlying illness and the treatment goal for each patient. A mere treatment recommendation, however, is not enough for the tax authorities; the statutory or private prescription remains the simplest and safest proof.
Yes, not with two tills, but with clear lines within one: separate product groups for medical treatment, cosmetic care and product sales, plus separate revenue accounts in the bookkeeping. That way the evidence for VAT and profit determination arises automatically in day-to-day business. In a joint practice the same separation additionally protects against nasty surprises with trade tax (Gewerbesteuer), because the de minimis thresholds can only be monitored in this way.
A statutory or private prescription is the safe proof of the therapeutic purpose; a mere verbal or informal "recommendation", by contrast, is not enough for the tax authorities. Exemption is not ruled out entirely without a prescription: in that case the medical indication must be documented for each patient, for instance with findings, a link to the diagnosis and the treatment goal. For this we define a three-line standard that runs alongside the treatment process and serves as proof if the tax authorities have queries, without making your day any longer.
No, one till is enough if it is set up correctly: with separate product groups for medical treatment, cosmetic foot care and product sales, as well as separate revenue accounts in the bookkeeping. That way the evidence for VAT and profit determination arises automatically when payment is taken. What matters is the consistent allocation of every appointment from the outset; sorting things out afterwards is error-prone and expensive. We set up the till and the chart of accounts once to fit, and brief your team on the system.
For podiatry practices, the service catalogue including the split into medical and cosmetic helps. For an initial assessment a few things are enough: the latest business analysis (betriebswirtschaftliche Auswertung) or the latest tax assessment notice (Steuerbescheid), an overview of your service areas and, if available, the current list of accounts. 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 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, telephone or in person, as you prefer. This means support is not tied to the firm's location; what is decisive is sector knowledge, not the postcode. Whether the appointment and till data from your system can be taken over, and which tools will actually be used, is something we examine together with you during the setup.
In podiatry practices the share of cosmetic services affects the scope. The fee follows the Tax Advisers' Fee Regulation (Steuerberatervergütungsverordnung) and depends on the values in dispute, the scope of services and the effort involved; for ongoing services flat-fee agreements are possible. You will receive a sound offer after the initial consultation; for that, the latest analysis, the number of documents and the desired components are enough. We do not consider made-up fixed prices without a look at your practice to be reputable.
Your next step
Medical or cosmetic: we classify your range of services together in the initial consultation. After your enquiry you will receive a confirmation of receipt; your permanent contact person will then get in touch. Still getting your bearings? We answer the most frequent questions directly at the top of this page.