Opening a hearing-aid centre in 2026: diploma, status and steps

Quick answer. Opening a hearing-aid centre first requires the State Diploma of audioprosthetist, the only qualification that authorises you to dispense hearing aids (Public Health Code, art. L4361-1). You then register with the Regional Health Agency and obtain an RPPS number, which replaced the ADELI register on 5 June 2024. The centre is a mixed activity, both care and trade, with VAT at 5.5 % and 20 % and a cash cycle shaped by third-party payment.

A hearing-aid centre is neither a simple medical-device shop nor a pure care practice. It is precisely this dual nature, half-health and half-trade, that complicates management and trips up most project holders in the first months. In creation files in this sector, the friction almost never comes from the diploma or the registration, which are well-marked steps, but from VAT configuration, third-party payment tracking and a legal structure chosen too quickly. Here is how to frame the whole picture before signing a lease or ordering a booth.

Yes, and it is a non-negotiable prerequisite. Practising the profession requires the State Diploma of audioprosthetist, a three-year course registered with the RNCP under number 36110. Without this diploma, you can neither practise nor dispense hearing aids.

The Public Health Code is unambiguous: the audioprosthetist is the only professional authorised to dispense hearing-correction devices (articles L4361-1 and L4361-3). This monopoly covers the technical fitting act, meaning the assessment, the choice of device, the adjustment and the patient follow-up.

The nuance, often misunderstood, lies in the distinction between the care act and company ownership. You can perfectly well be a non-qualified investor or director of a company that operates a centre, on the strict condition that a qualified audioprosthetist carries out the technical acts. This is a point we systematically check when a project holder wishes to open several centres relying on salaried practitioners: the legal architecture must guarantee, at each opening, the effective presence of an authorised qualified professional, failing which the dispensing activity is irregular.

No. Unlike pharmacists, doctors or dental surgeons, the audioprosthetist does not belong to a professional Order. This absence of an Order lightens the ethical side, but it does not exempt you from any health identification formality.

You must register with the Regional Health Agency (ARS) for your place of practice (article L4361-2 of the Public Health Code). Since 5 June 2024, audioprosthetists have been identified by an RPPS number (shared register of healthcare professionals), which replaced the former ADELI register. This number is not a mere administrative line: it governs your agreement (conventionnement) and your billing with the health insurance fund. No RPPS, no possible third-party payment, therefore no smooth reimbursement for your patients.

Hayot Expertise tip. Treat the ARS registration and the RPPS number as blocking steps, on a par with signing the lease. A centre that opens without an operational agreement collects everything directly from the patient, which sharply lowers the quote conversion rate and weakens cash flow in the first months.

Because it sells medical devices, a commercial act, in addition to the care service, and because the profession is not regulated by an Order, the audioprosthetist has access to a wide range of legal forms. This is a welcome freedom, but it calls for a real trade-off.

The right choice depends on your real project, not on a theoretical preference. Three questions structure the decision:

1. Alone or with partners? A single centre run alone can stay as a sole trader; a network project or the entry of partners points towards a company.
2. Which social regime and which remuneration? The status determines whether you fall under the self-employed regime or the employee-treated regime, with direct consequences for contributions and social cover. The trade-off between salary and dividends is prepared upstream: we set out our approach to optimising director remuneration.
3. Which financing? A heavy investment, a booth, an initial stock, a fit-out, is more naturally financed in a structure able to take on a loan and, where relevant, a partner.

There is no universal answer. The chosen form determines your taxation, your social regime and your ability to bring in a partner later. Best to calibrate it before signing the lease: changing it afterwards costs time and notarial fees. Our firm secures this step as part of its business creation services in Paris.

This is the accounting specificity of the trade, and the most frequent source of error. A hearing-aid centre invoices both a care service, the assessment, the fitting and the follow-up, and sells products, the devices, the accessories and the batteries. These two natures do not fall under the same VAT rate, and the configuration must be correct from the very first invoice.

The underestimated risk is concrete: a poorly configured till applying a single rate mechanically distorts VAT returns. The error accumulates with each sale and stays invisible until an audit occurs. We therefore recommend mapping the product catalogue by rate from opening day, and linking the till to the accounting tool to eliminate re-keying and the discrepancies it creates.

Since the 100 % Santé reform, every quote given to the patient must include at least one Class I device, with zero out-of-pocket cost. This is not an optional commercial choice, it is a presentation obligation: a quote offering only Class II devices is non-compliant.

On the management side, this mechanism works through third-party payment (tiers payant). You advance the portion reimbursed by the health insurance fund and the complementary insurers, then collect these receivables with a delay, sometimes of several weeks. These amounts are not a detail: they form a receivables item to be tracked in your cash flow as a full line.

The consequence is counter-intuitive. A centre can show a positive result on paper and still face cash-flow tensions, simply because third-party payment collection is not managed. The gap between the sale, the advance and the collection creates a working capital requirement that must be financed.

Opening a centre requires premises accessible to people with reduced mobility, measurement equipment, a soundproof booth and an audiometer, an initial stock of devices and accessories, and the fitting-out of the sales space. The amount varies greatly depending on the city, surface area and positioning.

We never communicate a typical budget, because none exists: a neighbourhood centre in the regions and a point of sale in central Paris do not have the same financing plan. Instead, we always build a costed forecast based on your real project. This forecast serves three precise purposes:

• Talk to the bank with a credible, documented financing file;
• Size the working capital requirement, which combines stock and the third-party payment advance;
• Set the turnover threshold from which the centre becomes profitable.

Several configurations deserve specific attention before opening:

• The non-qualified project holder. Investment is possible, but the technical act must be carried out by a qualified professional. The practitioner's employment contract and the company's governance must guarantee this presence at all times.
• A network project from the start. Opening several centres in parallel changes the structure trade-off and the cash-flow sizing. The SAS often imposes itself to accommodate partners and a pooled loan.
• Taking over an existing centre. Buying a business changes the logic: taking over stock, agreement contracts and third-party payment history. Valuation and acquisition due diligence become a priority over the opening forecast.

• Check the effective presence of a qualified audioprosthetist at every dispensing point, without exception.
• Do not start third-party payment billing before obtaining the RPPS and the agreement.
• Configure multi-rate VAT from the very first sale, not after the first financial year.
• Track third-party payment receivables as a distinct cash-flow item, with follow-ups.
• Settle the legal status before signing the lease, not after opening.

In a recent file for the creation of a hearing-aid centre, the project holder, an experienced audioprosthetist, had anticipated everything on the technical side: premises identified, booth ordered, suppliers chosen. The management side, however, had been postponed. The chosen till applied by default a single rate of 20 % to all sales, including hearing aids that fall under 5.5 %. Over the first weeks, this meant overstated collected VAT and a displayed price inconsistent with 100 % Santé.

We reworked the configuration ahead of opening, split the catalogue by rate and connected the till to the accounting system. In parallel, we built the cash-flow forecast by isolating the third-party payment advance, which the project holder had not quantified. The actual working capital requirement was clearly higher than his initial estimate, which led to renegotiating the loan amount before signing.

Our conviction is simple: in this sector, the diploma and the registration belong to the audioprosthetist's profession, but the status, VAT and cash flow are decided at the same time as the technical project, never afterwards. The legal form influences taxation and remuneration from the very first euro collected; third-party payment determines cash flow from the very first sale. Postponing these topics means accepting to fix them later, at a higher cost.

Our firm supports project holders in the sector: you will find the detail of our approach on our page dedicated to accounting expertise for audioprosthetists, and we regularly cross these issues with those of hearing-aid reimbursement, covered in our article on 100 % Santé in audiology and hearing-aid prices.