Private doctor VAT and invoicing in Paris in 2026: care exemption, taxable acts and e-invoicing

Updated 12 May 2026. A private doctor's VAT position in Paris cannot be reduced to the broad exemption of medical care. It plays out at the boundary between therapeutic act, aesthetic act, expert opinion, training, equipment rental, recharge between practitioners and platform commission. Each inbound or outbound flow must be qualified against the specific article of the French Tax Code (CGI) that governs it, and every invoice issued must carry the mentions required by Article 289 CGI. The electronic invoicing reform, whose calendar was set by Decree No. 2024-1098 of 4 December 2024, adds a technical obligation that even a purely exempt care practice can no longer ignore from 2026 onwards. This article focuses exclusively on VAT and invoicing for the private doctor in Paris in 2026; we refer to related articles for the general BNC vs SELARL tax regime, the medical practice KPIs, the recurring accounting errors and the sector grants and exemptions.

The principle: exemption without right to deduction#

Article 261-4° 1° of the French Tax Code exempts from VAT "care provided to persons by members of the regulated medical and paramedical professions". The exemption applies as of right: the doctor has no option to elect, no CA3 turnover declaration to file, no VAT to collect on care fees. The counterpart, codified in Article 271 CGI, is that no upstream VAT borne on the practice's purchases (medical equipment, rent, electricity, Doctolib or Maiia software subscriptions) is deductible. The VAT borne on these expenses is built into the cost and recorded as a gross charge (accounts 606, 613, 622, 626 depending on nature).

The cumulative conditions of the exemption#

Three cumulative conditions must be met for an act to benefit from the exemption. First condition: the person performing the act must hold a diploma recognised by the French State — doctor, dentist, midwife, physiotherapist, nurse, speech therapist, orthoptist, chiropodist, ostéopathe DO or chiropracteur DC registered with the ADELI registry. Second condition: the act must constitute care with a therapeutic purpose, meaning that it aims at the diagnosis, treatment or prevention of a disease or health condition. Third condition: the act must be provided directly to the person, which excludes advisory services rendered to institutional third parties.

European case law: the therapeutic purpose is the decisive criterion#

The Court of Justice of the European Union has ruled several times on the scope of the exemption set out in VAT Directive 2006/112/EC, of which Article 261-4° 1° CGI is the French transposition. The CJEU judgment C-91/12 PFC Clinic AB of 21 March 2013 held that aesthetic surgery only benefits from the exemption if it pursues a therapeutic purpose, which the practitioner must establish on a case-by-case basis. The CJEU judgment C-86/09 Future Health Technologies of 10 June 2010 specified that the exemption does not apply to services whose purpose is purely preventive of a hypothetical risk, outside any diagnosis. The BOFiP doctrine BOI-TVA-CHAMP-30-10-20-10 has integrated these judgments: the documentary traceability of the therapeutic purpose has become an audit issue in its own right.

Consultations, teleconsultations, diagnostic acts#

The following are exempt without difficulty: all general practice and specialist consultations covered by the social security system, teleconsultations reimbursed by health insurance since the decree of 3 June 2021, diagnostic acts (ultrasound, MRI, CT scan, biopsy), reconstructive or therapeutic surgery, vaccination acts, and therapeutic dermatology (treatment of melanoma, eczema, psoriasis). For these acts, the invoice must carry the mention "VAT exemption — Article 261-4° 1° of the CGI"; no VAT line should appear.

Occupational medicine, school medicine, therapeutic sports medicine#

A doctor employed by an occupational health service (SST), a school doctor paid by the National Education ministry, and a sports doctor providing therapeutic follow-up to an injured athlete also fall under the exemption, provided the act retains its preventive or curative purpose. The remuneration paid by the employer or the public body remains outside the VAT scope. By contrast, a consulting service rendered to a sports federation on the design of a return-to-effort protocol may shift into a taxable consulting activity and lose the exemption.

Pure aesthetic surgery and comfort acts#

Pure aesthetic surgery without therapeutic purpose is subject to VAT at 20 %: comfort rhinoplasty, cosmetic cervico-facial lifting, aesthetic blepharoplasty, breast augmentation without reconstructive history, aesthetic peeling, botox injections for cosmetic purposes without underlying pathology, purely cosmetic dental whitening, hair implant for ordinary baldness. On these acts, the doctor collects 20 % VAT, which must be paid back to the administration via the monthly CA3 return or the annual CA12 return depending on the regime.

Medical expert opinion, conferences, publications, clinical research#

Medical expert opinions performed on behalf of an insurance company, a court (judicial expertise) or a retirement fund are subject to VAT at 20 %: the purpose is administrative, not therapeutic, and the beneficiary is not the patient but a third party. Speaker fees, royalties on paid publications, and clinical research paid by a pharmaceutical laboratory generally fall under the same regime, subject to case-by-case qualification. Sales of derivative products (food supplements, medical devices outside reimbursed prescription, cosmetics) are fully subject to VAT at 20 %.

The clinical trade-offs that flip the VAT qualification#

The boundary between exempt therapeutic act and taxable aesthetic act is rarely binary. Breast reconstruction after mastectomy for cancer is therapeutic and exempt. Comfort breast augmentation, without oncological history, is aesthetic and taxable. A hair implant after scarring alopecia following a burn is therapeutic. A hair implant for ordinary androgenetic baldness is aesthetic. A corrective rhinoplasty after a documented nasal fracture is therapeutic. A pure-convenience rhinoplasty is taxable. In the grey zone, the medical file documentation will decide in case of audit.

The documents to keep to secure the qualification#

BOFiP doctrine and CJEU case law converge: the practitioner must be able to produce, on request of the administration, the documentation establishing the therapeutic purpose of the exempt act. This documentation includes the referring doctor's or specialist's prescription, the operative report mentioning the indication, the preoperative imaging or laboratory work, the patient's medical history, and where applicable the opinion of a multidisciplinary consultation meeting. Failing that, the administration can re-qualify the act as a taxable aesthetic service and claim the uncollected VAT plus late interest and penalties. The retention period is aligned with the statute of limitations: 10 years from the operation (Article L102 B of the LPF).

The principle of direct allocation#

A private doctor running a mixed activity — exempt care and taxable aesthetic acts, or exempt care and expert opinions — must apply the deduction rules set out in Article 271 CGI and detailed in the BOI-TVA-DED-20 doctrine. The first rule is direct allocation: VAT borne on a good or service used exclusively for the taxable activity is fully deductible; that borne on a good or service used exclusively for the exempt activity is not deductible. This is the case, for example, of a dermatology laser used solely for aesthetics (deductible VAT) versus an ultrasound machine used solely for diagnostics (non-deductible VAT).

The deduction coefficient for mixed expenses#

For mixed expenses — practice rent, electricity, secretarial support, management software — a global deduction coefficient must be calculated. The general deduction coefficient is made up of the taxability coefficient, the taxation coefficient and the admission coefficient. In practice, it amounts to applying to upstream VAT a percentage equal to the ratio of taxable turnover / total turnover. Separate accounting of exempt revenue and taxable revenue becomes mandatory, generally through analytics configured in Pennylane, Tiime or Indy with breakdown by section.

The mechanism of Article 293 B CGI#

Article 293 B CGI allows service providers whose annual taxable turnover stays below a threshold to benefit from a base franchise: no VAT is collected, no upstream VAT is deductible, no CA3 return is filed. For 2026, the base franchise threshold applicable to services is set at €37,500 (subject to evolution in finance law; to be checked manually as of the application date). A private doctor mainly in sector 1 who occasionally performs a few aesthetic acts for an annual volume below €37,500 can therefore stay under the base franchise on their taxable share.

The option for VAT and crossing the threshold#

The doctor may, by way of an option filed with the corporate tax office, waive the base franchise and become a taxable VAT-liable person from the first euro of the activity concerned. This option is irrevocable for two calendar years. It is relevant when the deduction of upstream VAT (laser purchase, chair purchase, recharge from an SCM) exceeds the VAT collected. In case the threshold is crossed during the year, the franchise ends on the first day of the month of exceedance.

The mechanism for pooling resources#

Several private doctors sharing the same practice in Paris can set up a Civil Means Company (SCM) governed by Article 36 of the Law of 29 November 1966 and Articles 1845 et seq. of the Civil Code. The SCM provides its members with practice resources: premises, medical equipment, secretarial support, running costs. It does not perform any medical act; it recharges its members for their share of expenses, at cost.

The VAT exemption on cost-only reimbursements#

Article 261 B CGI exempts from VAT "services rendered to their members by groupings made up of persons carrying out an exempt activity", on the dual condition that the SCM invoices at exact cost (no margin) and that the share recharged corresponds to the effective use of the resources by each member. The SCM must keep separate accounts and provide an annual allocation account. In case of any margin, however small, or of recharge to a non-member third party, the exemption falls and 20 % VAT becomes due on the entire recharges of the financial year.

Identification of the doctor and the patient#

Any invoice, whether for an exempt or a taxable act, must include the mentions of Article 289 CGI: full identification of the doctor (last name, first name, professional address, RPPS number, ADELI number where applicable, SIREN or SIRET if practising as a company), identification of the recipient where the invoice is requested (third-party paying body, mutual fund for a taxable act, employer), continuous chronological numbering, invoice date, date of the act where different.

Specific mentions by VAT regime#

For an exempt act, the invoice must carry the mention "VAT exemption — Article 261-4° 1° of the CGI" without any VAT line. For a taxable act, the invoice must show the price excluding VAT, the VAT rate (20 %), the VAT amount and the price including VAT. For a doctor under the base franchise, the mention "VAT not applicable, Article 293 B of the CGI" replaces VAT. The nature of the act (CCAM or NGAP wording) and the unit price must appear on the invoice. The retention period for invoices is 10 years (Article L102 B of the LPF).

The deployment calendar and the doctors concerned#

Decree No. 2024-1098 of 4 December 2024 set the definitive calendar for inter-business electronic invoicing in France. On 1 September 2026, all businesses — including private doctors operating as BNC, SELARL or SELAS — are required to receive electronic invoices issued by their taxable suppliers (commercial rent, medical equipment purchase from a business supplier, Doctolib subscription invoiced by the platform). On 1 September 2026, mandatory issuance concerns large companies and mid-caps; doctors are not concerned at that date except in marginal cases. On 1 September 2027, mandatory issuance is extended to SMEs and microenterprises: private doctors enter the scope for their invoices issued to professional clients (insurance, third-party paying entity, employer in the context of liberal occupational medicine).

PDP, PPF and specialist healthcare platforms#

Issuance and reception necessarily go through a platform: either the Public Invoicing Portal (PPF) operated free of charge by AIFE, or a registered Partner Dematerialisation Platform (PDP). The most widely used PDPs in practice include Pennylane, Sellsy, Esker and Tiime, with native connectors to accounting software. Doctolib Facturation and Maiia Facturation offer modules adapted to medical specifics (CCAM management, third-party payment, integration to the patient record). The standard formats are Factur-X (PDF/A-3 with embedded XML), UBL and CII. The paper or plain PDF invoice will no longer be enforceable between taxable persons from 1 September 2026 for reception and 1 September 2027 for SME issuance.

Doctolib, Maiia, Qare commissions: subject to 20 %#

Medical platforms invoice their referral commission and subscription to the doctor with VAT at the standard 20 % rate. For a doctor under the base franchise or fully exempt without taxable activity, this VAT is not deductible: it constitutes a net charge recorded in account 6228 (commissions and platform fees) or 626 (postal and telecommunication expenses depending on package nature). For a doctor with a mixed activity, VAT on the commission is deductible at prorata, via the deduction coefficient calculated on taxable turnover.

Third-party payment and patient flow: a transparent mandate#

When the platform collects payment on behalf of the doctor (online card payment by the patient) or the third-party payment from health insurance, it acts as a transparent mandatory: the sum transits through a technical account and is paid back to the doctor. No VAT is due on this collection flow, which retains the original nature of the act (exempt or taxable). The correct accounting treatment is: platform collection on account 5121 or 467, transfer to the doctor on professional bank account 5121, fees in account 706 (or 7061/7062 if analytical split care / aesthetic), platform commission in account 6228, and deductible VAT where applicable in account 44566.

The dominant risk: an ancillary activity becoming regular without VAT adaptation#

In the private doctor files we handle in Paris, the most frequent risk is neither a total VAT oversight nor over-declaration: it is silent drift. A dermatologist starts performing a few cosmetic botox injections for regular patients; three years later, the activity represents €80,000 of turnover without any VAT ever having been collected or declared. The reassessment over three financial years can reach €48,000 excluding penalties. The point is to put in place from day one practice analytics that separate therapeutic care from taxable acts, and to revisit the VAT status each year at the closing.

The Cabinet Hayot Expertise method on private doctor VAT#

Our method runs in six steps. First, map all the practice's flows — care, aesthetic acts, expert opinions, conferences, sales, SCM recharges, platform commissions. Second, qualify each flow against Article 261-4° 1°, 261 B, 271 or 293 B depending on nature. Third, calibrate a possible deduction prorata where the activity is mixed. Fourth, set up invoicing so that the mentions of Article 289 are automated (wording, rate, exemption mention). Fifth, choose and deploy a PDP in view of the 1 September 2026 deadline (reception) and 1 September 2027 (issuance). Sixth, document the therapeutic purpose of grey-zone acts through clinical evidence kept for 10 years. You can reach out via our Paris 8 accounting and audit team or our outsourced CFO service for a dedicated VAT audit of a medical practice, in synergy with the digitalisation and partner solutions deployed for electronic invoicing.