Osteopath in 2026: BNC profits, VAT exemption and tax regime

Quick answer. Osteopath income is classified as BNC (non-commercial profits). Therapeutic acts are VAT-exempt (French tax code Article 261-4-1°); non-therapeutic services (wellness, expert assessment) remain subject to standard 20% VAT. Up to EUR 83,600 net annual revenue, the micro-BNC regime applies automatically with a 34% allowance; above, standard accounting (form 2035) permits deduction of actual business expenses.

An osteopath practising as a self-employed professional in France must meet strict training and title requirements. Decree No. 2007-435 of 25 March 2007 governs the profession and defines who may lawfully use the title of osteopath: a person holding a state-recognized diploma, registered on the list of osteopaths held by the regional health agency (ARS). This registration is mandatory before any professional activity begins.

Recently, an expanding multi-site osteopathy practice asked us to restructure its accounts after adding wellness services alongside therapeutic treatment. The tax authorities had flagged uniform VAT treatment across all revenue streams, without distinguishing therapeutic acts (VAT-exempt) from comfort services. This error cost thousands in VAT incorrectly invoiced and unrecovered.

Therapeutic acts: exemption mandatory#

Article 261, paragraph 4°, section 1° of the French Tax Code exempts:

"Healthcare and human health services provided by a professional authorized to use that title" — where the purpose is to prevent, diagnose or treat a pathology or functional disorder.

For an osteopath, this means:

• osteopathic manipulation aimed at correcting somatic dysfunction (vertebrae, ribs, joints, muscles, fasciae, organs) is VAT-exempt;
• osteopathic diagnosis (palpation, functional tests) preceding treatment also falls within this exemption;
• the service is invoiced net of VAT (no VAT is added).

This exemption is not a threshold: it rests on therapeutic purpose certified by Decree 2007-435, which authorizes the osteopath to practise.

Non-therapeutic services: standard 20% VAT applies#

Conversely, non-therapeutic services must be subject to standard VAT:

• wellness or relaxation sessions unrelated to a diagnosed pathology;
• expert assessment (reports for third parties: employers, insurers, legal counsel);
• coaching or training sessions without therapeutic intent;
• product sales (creams, massage oils): 20% VAT;
• comfort services without medical purpose.

An osteopath invoicing a mixed service (therapeutic + wellness) must split and justify the therapeutic portion: the tax authority may reclassify as standard-rate VAT if proof is lacking.

Documentation required to prove exemption#

The BOFiP (French tax administration doctrine) requires proof of therapeutic purpose based on:

• consultation reason (documented medical history);
• diagnostic tests performed;
• description of treatment applied;
• where relevant, differential diagnosis excluding contraindications.

During a tax audit, missing patient records or treatment descriptions may cause the tax authority to reclassify the service as standard-rate (20%) VAT and assess back taxes plus penalties.

Osteopath income is classified as BNC (bénéfices non commerciaux — non-commercial profits). This means it falls under personal income tax in the BNC category, not corporate income tax (which would apply to commercial profits).

Two regimes apply to an osteopath:

1. Micro-BNC: simplified declaration regime#

Threshold 2026: up to EUR 83,600 net annual revenue (revalued by the 2026 Finance Act; Official Journal 20 February 2026).

Applicability: automatic if revenue stays below the threshold. No option request needed.

Profit calculation:

• Flat-rate allowance of 34% on net revenue (minimum EUR 305).
• No deduction of actual expenses: office rent, equipment, supplies, medical materials, professional training, liability insurance premiums are not deductible from taxable profit.

Declaration: receipts are reported on the supplementary return 2042-C-PRO (micro-BNC section); no 2035 schedule is required.

Social contributions: the micro-BNC operator is affiliated with CIPAV (Caisse interprofessionnelle de prévoyance et d'assurance vieillesse — the self-employed healthcare professionals' pension fund). Contributions are calculated on profit after the allowance and collected via URSSAF; the rate depends on the activity and the affiliation fund.

Advantage: administrative simplicity, minimal record-keeping.

2. Standard accounting: actual expense deduction#

Obligation: above EUR 83,600 net, standard accounting (Form 2035) becomes compulsory after two consecutive years exceeding the threshold.

Option: available even below the threshold, on request to the local tax office.

Profit calculation:

• Net revenue minus all deductible actual business expenses: office rent, utilities, medical equipment, supplies, professional liability insurance, mandatory continuing education, union fees, telephone, internet, minor equipment, business entertainment.
• Depreciation of long-lived assets (furniture 10 years, medical equipment 5–10 years).

Declaration: Form 2035 (full) with accounting annexes (balance sheet and income statement).

Social contributions: same method as micro-BNC, calculated on actual net profit (after expense deduction).

Advantage: higher net profit if actual expenses exceed 34% of revenue; credibility with third parties (banks, insurers).

An osteopath operating as an independent (sole proprietor, EURL, SAS electing BNC taxation) is affiliated with CIPAV for old-age insurance, disability, death benefits and accident insurance.

2026 contribution rates#

Contribution rates for a self-employed healthcare professional in 2026 are:

• Contributions (health, CIPAV pension, disability-death, CSG-CRDS) are based on taxable profit (micro-BNC) or actual net profit (standard accounting) and collected via URSSAF.

This rate varies depending on:

• regime chosen (micro or standard);
• calculation base (profit after allowance or actual net profit);
• optional supplementary pension contributions (the Madelin pension contract has been closed to new subscriptions since 1 October 2020, replaced by the PER).

Since 2022, the 1.25× surcharge for non-membership in an approved accounting firm has been abolished. This surcharge, formerly applied to micro-entrepreneurs, no longer adds to contributions.

Sole proprietorship#

The osteopath operates individually in their own name. Income is taxable as personal income in the BNC category.

Advantage: no formal business structure, administrative simplicity.

Disadvantage: unlimited personal liability (personal assets at risk in case of claim).

EURL (single-member limited-liability company)#

The osteopath can form an EURL with themselves as sole member, electing BNC taxation (otherwise corporate income tax applies).

Advantage: limited liability to capital contributed.

Disadvantage: formation procedures, heavier accounting requirements.

SAS (simplified joint-stock company)#

Multiple osteopaths or partnership with investors. The managing member can elect BNC taxation (otherwise corporate tax).

Advantage: flexibility, commercial credibility.

Disadvantage: employer contributions on manager salary if the manager is a salaried employee of the SAS.

Shared practice and locum arrangements#

Two osteopaths may share office space, each retaining self-employed status and paying a fee split (typically 20–40% of patient revenue) to the principal.

Accounting impact: the fee split is a deductible business expense for the locum; additional income for the principal.

Osteopath also offering wellness coaching#

If wellness or relaxation coaching is clearly distinct from therapeutic osteopathy, it must be invoiced at 20% VAT and recorded separately. The tax authority may demand segregation of revenue to justify the exemption for therapeutic services.

Equipment purchases and investment#

Under micro-BNC, purchases of equipment (examination table, diagnostic devices) are not depreciable: they are not deductible. This cost simply reduces available cash.

Under standard accounting, these investments may be depreciated over their useful life (furniture 10 years, medical devices 5–10 years), reducing taxable profit annually.

Professional liability insurance#

Under micro-BNC, this premium is not deductible. Under standard accounting, it is fully deductible. This can justify switching to standard accounting if the premium is substantial.

Mistake 1 — Invoicing all services at 20% VAT#

Many osteopaths invoice without distinction at standard VAT. This is incorrect: therapeutic acts must be VAT-exempt. This confusion can result in significant VAT assessments.

Mistake 2 — Failing to document therapeutic purpose#

Without patient files or treatment descriptions, the tax authority may reclassify as standard-rate VAT. Good documentation (reason for visit, diagnosis, treatments performed) is your best defence.

Mistake 3 — Not splitting mixed-service invoicing#

If you provide both osteopathic treatment and a relaxation session, invoice them separately. Combining them risks complete reclassification as standard-rate VAT.

Mistake 4 — Overlooking the micro-BNC threshold#

Once you exceed EUR 83,600 net for two consecutive years, you must switch to standard accounting. Remaining on micro exposes you to systematic adjustment.

Mistake 5 — Failing to plan for growth#

Under micro-BNC, the more you earn, the more potential deductions you leave on the table. A thriving practice with EUR 150,000 net revenue might deduct EUR 50,000 of expenses under standard accounting instead of applying the 34% flat allowance.

Osteopath taxation hinges on three elements: VAT exemption (rare in self-employed professions), choice of regime (micro vs. standard), and business structure (sole proprietorship, EURL, SAS).

What strikes us working with growing osteopathy practices is the widespread misunderstanding. Many assume VAT exemption is universal — when it applies strictly to therapeutic acts. As soon as there is diversification (coaching, product sales, expert assessment), you must segregate. Otherwise, a VAT reassessment on incorrectly invoiced services can wipe out years of margin.

The micro vs. standard choice is critical too. A solo practice earning EUR 90,000 net with substantial rent, insurance and supplies might earn far more under standard accounting — but requires rigorous bookkeeping (retained invoices, documented expenses). A disciplined micro-entrepreneur staying under EUR 83,600 avoids this complexity.

At Hayot Expertise, we have set up several osteopathy practices under standard accounting, with strict tax-accounting oversight: segregation of therapeutic and non-therapeutic revenue, equipment depreciation, CIPAV contributions. The result: a clear picture of actual profit and credibility with third parties (banks, insurers).

Hayot Expertise advice. Before exceeding EUR 83,600 net, calculate your tax burden under micro vs. standard regimes. If your deductible expenses (rent, insurance, training, equipment depreciation) exceed 34% of revenue, switch proactively to standard accounting — do not wait to be forced. Also, meticulously document the therapeutic purpose of each act: dated patient file, diagnosis, treatment description. This documentation protects you against tax authority scrutiny of your VAT exemption claim.