Bookkeeping for the self-employed physiotherapist: exemption, locums and claims
Written by Ilias Aarrass7 min read · Published on · Last reviewed on 
In short
Treatments by a registered physiotherapist are exempt from VAT, but workshops, stand-alone massages and selling tape are taxed at 21 per cent.
- Exempt also means: no VAT deduction on your treatment table, practice rent and training.
- Locum work in a practice as a registered professional stays exempt; record the arrangements in writing.
- With mixed turnover you split input VAT in proportion and recalculate at year-end.
- For income tax nothing changes: your profit is taxed and your hours count towards the hours criterion.
As a self-employed physiotherapist you sit in a separate tax corner. Your treatments fall under the VAT exemption for healthcare, so you send invoices without VAT and often file no VAT returns at all. That sounds easy, but it has a downside: you do not get back the VAT on your treatment table, your tape and your practice rent. And as soon as you do something alongside it, a workshop, a sports massage or advice to a company, that can be taxed. This article explains where the line runs, how locum work operates and what to watch when claiming.
The exemption: when does it apply?
The VAT exemption for healthcare applies to care of the individual by practitioners with a professional registration, and only to work within their field of expertise. For a physiotherapist that means: your treatments are exempt, whether the patient pays directly or it runs through the health insurer. Your invoice then contains no VAT and no VAT amount.
Outside that field the picture changes. A relaxation massage without medical grounds, a workshop for a sports club, a company course on posture or selling tape, braces and exercise equipment are in principle taxed. The exemption attaches to the nature of the service, not to your diploma. If you do both, read splitting VAT on taxed and exempt turnover and the general VAT exemption in healthcare.
| What you do | VAT |
|---|---|
| Treating a patient within your field | Exempt |
| Working as a registered locum in a practice | Exempt |
| Relaxation or sports massage without medical grounds | 21% |
| Workshop or course for a company or club | 21% |
| Selling tape, braces and exercise equipment | 21% |
Locum work or your own practice
Many self-employed physiotherapists work as locums in someone else's practice. You then invoice that practice, exempt from VAT, usually as a percentage of turnover or a fixed amount per session. Put that arrangement in writing: who claims from the insurer, who bears the risk of unpaid claims and who handles the records.
If you work long term for one practice, at fixed times, with their diary and their equipment, the question arises whether you are genuinely independent. Since 2025 the tax authorities actively enforce the rules on false self-employment, and healthcare is a focus sector. Make sure you have several clients, your own rates and your own professional liability insurance. See false self-employment and the DBA act and how many clients you need.
If you rent a treatment room yourself, that rent is usually exempt from VAT. That is no problem for you, since you cannot deduct VAT anyway, but it does mean the landlord cannot pass on their VAT on maintenance and often builds it into the rent. What else you deduct with rented premises is covered in renting business premises.
Claims, debtors and your records
If your revenue runs through health insurers, time passes between treating and being paid, and sometimes a claim is rejected. Do not write a rejected or corrected claim off as a cost, but correct your revenue, so your records match what actually comes in. If you also treat private patients, the ordinary rules for invoices and reminders apply; see debtor management.
For income tax the exemption changes nothing: your profit is taxed as usual, your hours count towards the 1,225-hour criterion and your costs are deductible, even where the VAT on them is not. Practice software, refresher training, your professional association and your quality registration are all business costs, see training costs and trade literature and memberships.
Worked example: a mixed practice
- Exempt treatment revenue
- € 58,000
- Taxed revenue from company workshops
- € 7,000 + € 1,470 VAT
- Taxed share of your revenue
- 11%
- VAT on a new treatment table of € 2,000 excluding VAT
- € 420, of which about € 46 deductible
Result: Because your table is mainly used for exempt work, you get back only a small part of the VAT. The rest counts in the purchase price you depreciate. For income tax the whole table is simply an investment.
Frequently asked questions
Do I file VAT returns if all my turnover is exempt?
Usually not. If you are exclusively exempt, you do not file VAT returns. If you buy from abroad or also have taxed turnover, that can be different.
Is a sports massage exempt too?
Only if it is part of a treatment within your field. A stand-alone relaxation or sports massage without medical grounds is taxed at 21 per cent.
Can I reclaim the VAT on my practice fit-out?
With fully exempt turnover, no. If you also have taxed turnover, you deduct VAT in proportion to that taxed share and recalculate at year-end.
I only work for one practice. Is that a problem?
Not necessarily, but it weakens your position when it is assessed whether you are in business. Several clients, your own rates and your own insurance make the case stronger.
Sources
- Exemption for medical professionalsBelastingdienst · belastingdienst.nl
- VAT exemption in healthcareBelastingdienst · belastingdienst.nl
Sources checked on
This article provides general information based on the rules known for 2026 and does not replace personal tax advice. For your specific situation, we're happy to take a look with you.
