Healthcare
Tax advisor for psychotherapists
From the statutory health insurance practice licence (Kassensitz) to the self-pay session: we bring order to the figures of your practice. The Kassensitz is often the largest investment of your working life, and how it is treated for tax purposes is decided in the purchase contract, not in the tax return. We advise psychotherapists on taking over a practice, on running it day to day and on handing it over: from the allocation of the purchase price, through separating tax-exempt therapy from taxable side activities, to the cash-basis profit and loss statement (EÜR) that shows you what your practice really earns per hour.
Focus areas for psychotherapists
- VAT-exempt medical treatment and the distinction from taxable services such as expert opinions without a therapeutic purpose, supervision or seminars
- Buying and selling a practice and a statutory health insurance practice licence (Kassensitz): depreciable practice goodwill (Praxiswert) or a non-depreciable licence advantage (Zulassung)
- Cash-basis profit and loss statement (EÜR) and advance tax payments where the cost ratio is low
- Business expenses: further training, self-experience work (Selbsterfahrung), supervision, practice premises and home study
- Practice sharing arrangement (Praxisgemeinschaft) or joint professional practice (Berufsausübungsgemeinschaft): the form of cooperation that fits from a tax perspective
The Kassensitz: the most expensive item, the biggest tax question
Anyone taking over a psychotherapy practice often pays less for the couch and the rooms than for access to the statutory health insurance system. From then on, one question determines the tax position for years: what did you actually buy? Practice goodwill (Praxiswert), meaning the patient base, the reputation and the running business, can be depreciated. A separately remunerated "advantage arising from the licence" (Vorteil aus der Zulassung), by contrast, cannot: for tax purposes it does not wear out. The courts draw the line according to whether you continue the practice as a whole or essentially acquire only the licence in order to start afresh elsewhere. That is why we accompany the tax allocation of the purchase price before you sign and coordinate with your legal advisors where needed; afterwards, little can be repaired.
Tax-exempt therapy, taxable side activities
Your curative psychotherapy is exempt from VAT (Umsatzsteuer). As soon as you leave that field, the picture changes: coaching, supervision without a connection to an illness, or expert opinions for courts and insurers pursue no therapeutic purpose and are as a rule taxable. Many practices slip unnoticed into VAT here, or conversely give away the room offered by the small-business scheme (Kleinunternehmerregelung), because nobody records the turnover separately. We sort your types of service through once thoroughly and then keep the separation running automatically in day-to-day work.
EÜR, chamber and pension provision under control
With freelance professional status (freiberuflich), the cash-basis profit and loss statement (EÜR) is enough for you; set up properly it is lean and informative at the same time. We take over the bookkeeping and the tax returns, keep your professional pension scheme (Versorgungswerk) and your retirement provision in mind, and provide you with analyses that show what your practice really earns: per hour, per quarter, per type of service. This lets you decide about hiring, expanding your premises or scaling back on the basis of figures rather than gut feeling. If your team grows, for example through employed colleagues or training arrangements, we watch with you over the core tax condition of freelance professional status (freiberuflich): you must give every treatment your professional stamp, from establishing the indication through to monitoring progress; mere organisation is not enough for the courts, documented case responsibility is. And if one day a handover or a relocation of the licence comes up, the same logic applies as when you started, only with the signs reversed: a clear purchase price structure then protects your proceeds. That is how we accompany practices through the entire cycle: from the first Kassensitz to an orderly handover.
A typical pitfall
Purchase price agreed as a lump sum "for the licence"? Then you risk a non-depreciable licence advantage. Before the contract is concluded, expressly regulate the allocation between practice goodwill (Praxiswert), inventory and the licence (Zulassung); we supply the tax wording support.
An example from our advisory work
Hypothetical example: a psychotherapist takes over half a statutory health insurance practice licence (Kassensitz) and additionally offers coaching for executives. The challenge: separating depreciable practice goodwill (Praxiswert) from the licence advantage and classifying the coaching correctly for VAT purposes. The matching service: tax support during the purchase plus separate recording of services. The intended benefit: depreciation from the first year, no unnoticed VAT liability. Next step: an initial consultation with the draft contract.
Frequently asked questions
In part: what can be depreciated is the practice goodwill (Praxiswert), that is, what you pay for the patient base, the organisation and the running business. By contrast, an amount that specifically compensates only the economic advantage arising from the licence (Zulassung) does not wear out, for example if you want to relocate the licence to another place. Whether your purchase price is the one or the other is decided by the contract and by whether the practice is actually continued; so clarify it before you sign.
What matters is not the method of payment but the content: self-paid psychotherapy with a connection to an illness remains tax-exempt. Services without a therapeutic purpose become taxable: coaching, couples or life counselling, supervision outside a course of treatment. Because both worlds often take place in the same practice, you need separate records; the tax-exempt core then stays untouched and the rest is treated correctly.
Expert opinions for courts, insurers or public authorities serve the decision-making of third parties, not treatment. They lack the therapeutic purpose, which is why they are as a rule subject to VAT (Umsatzsteuer). For income tax purposes they remain freelance professional income of your practice. It is worth checking whether the small-business scheme (Kleinunternehmerregelung) applies to this turnover; otherwise you issue the invoices showing tax and file the corresponding advance returns.
As long as you provide curative psychotherapy only, your turnover is tax-exempt; as a rule, neither VAT (Umsatzsteuer) nor ongoing advance returns then arise. It becomes different as soon as taxable services are added, for example coaching, supervision without a connection to an illness, or expert opinions: we then first check whether the small-business scheme (Kleinunternehmerregelung) applies and otherwise set up the advance returns for this area only. What matters is separate recording from the outset; it keeps the effort small and the classification clean.
On handover, the mirror image of what counts on entry applies: the proceeds are allocated to inventory, practice goodwill (Praxiswert) and, where applicable, the licence aspect, and this allocation influences how your disposal result is treated for tax purposes. Anyone who looks at the structure only after the notary appointment gives away room for arrangement. That is why we prepare the handover early: with a robust valuation, a tax-wise well thought-out contract structure and by taking your personal situation into account, for example your age and your pension entitlements.
For psychotherapy practices, the latest fee statement from the KV (Kassenärztliche Vereinigung) additionally helps to give a first picture. A few things are enough for an initial assessment: the most recent business analysis or the most recent tax assessment, an overview of your service areas and, if available, the current list of accounts. To take over your ongoing support, you receive a short checklist from us; we set up powers of attorney and data access together. You do not have to carry paper folders 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 on site, as you prefer. This means your support is not tied to the location of the firm; what is decisive is knowledge of the sector, not the postcode. For single-handed practices with tight time slots we look at how leanly the handover of receipts can be organised; which tools are actually used is something we agree with you during set-up, in line with the workflows of your practice.
For a single-handed practice with a cash-basis profit and loss statement (EÜR), the ongoing effort usually remains manageable. The fee follows the German tax advisor fee regulation (Steuerberatervergütungsverordnung) and depends on the values of the matters concerned, the scope of the services and the effort involved; flat-fee agreements are possible for ongoing services. You receive a firm quote after the initial consultation; for that, the most recent analysis, the number of receipts and the components you want are enough. We do not consider made-up fixed prices without a look at your practice to be sound.
Your next step
Are you planning to take over or hand over a Kassensitz? Talk to us before you sign. 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.