Invoicing as a physiotherapist

Billing VAT-exempt treatment, self-payers & mandatory details correctly

Key takeaways

Medical treatment is VAT-exempt: Medically indicated physiotherapy is exempt from VAT under § 4 No. 14 UStG.
Wellness & prevention are often taxable: Massages without medical indication or pure wellness offers are usually subject to 19%.
Self-payers & private prescription: For self-payers you invoice the patient directly – with a clear description of the service.
No VAT = no input tax deduction: For exempt services you cannot deduct input tax – this affects pricing.

VAT: exempt or liable?

The most important point for physiotherapists: medical treatments serving the diagnosis, treatment or prevention of illness and based on a medical prescription are VAT-exempt under § 4 No. 14 UStG. On such invoices you do not show VAT and add a note referring to the exemption.

Caution: Services without medical indication – e.g. wellness massages, prevention courses or personal training – are generally subject to VAT (19%). Separate these cleanly from medical treatments.

Mandatory details & remedies

In addition to the general mandatory details (§ 14 UStG), physiotherapy invoices should name the specific remedy service (e.g. "physiotherapy (KG), 6 units") and, where applicable, the reference to the medical prescription. For exempt services there is no VAT line; a note referring to § 4 No. 14 UStG is advisable.

Billing self-payers & private prescriptions

Invoice directly to the patient with a clear description of the service.
State the number of units and date/period.
Separate medical treatment (exempt) and additional service (taxable).
Do not forget the payment term and bank details.

Pricing without input tax deduction

Because exempt medical treatments do not allow input tax deduction, you bear the VAT on equipment, rent and materials yourself. Factor these costs into your prices. If you offer both exempt and taxable services, the input tax must be apportioned – coordination with your tax advisor is worthwhile here.

Avoiding common mistakes

Showing VAT on exempt medical treatments.
Wrongly treating wellness services as exempt.
Forgetting the note on the exemption.
Ignoring input tax apportionment for mixed services.

Frequently asked questions

Do physiotherapists have to charge VAT?

Not for medically indicated treatments – these are exempt under § 4 No. 14 UStG. For wellness, prevention without indication or personal training, 19% generally applies.

How do I bill self-payers?

Issue an invoice directly to the patient with a clear description of the service, number of units, date, amount and payment term.

Can I claim input tax?

Not for exempt medical treatments. A proportional input tax deduction is only possible for the taxable part of your services.

Do I need a note on the exemption?

Yes, it is advisable to refer to § 4 No. 14 UStG for exempt services so the missing VAT is comprehensible.

Does the e-invoicing mandate apply to physiotherapy practices?

Towards private patients (B2C) no. If you invoice companies (e.g. a rehabilitation provider acting as a business), the e-invoicing mandate may apply.

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