Our sector expertise
Chartered accountant for cardiologists
Specialist firm for self-employed cardiologists: 2035 return, BNC or SELARL, CCAM coding, sector 2 and OPTAM, CARMF pension contributions, SPFPL and wealth planning.
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Our expertise at a glance
As chartered accountants for self-employed cardiologists in Paris, we steer your practice on its three income levers: splitting your revenue by CCAM procedure (echocardiography, stress test, Holter), the convention trade-off (sector 1, sector 2, OPTAM) and structuring into a SELARL or SPFPL. With an average net income of EUR 170,766 in 2024, what matters is your actual disposable income, not the taxable result alone.
Our added value
- Rebuilding turnover by procedure (consultation, TTE at EUR 94.28, stress test, Holter, remote monitoring) to measure the real profitability of the technical equipment.
- Provisioning CARMF contributions (basic scheme, RCV at 11.80 %, ASV, invalidity-death), called with a two-year lag.
- Structuring a SELARL then an SPFPL with dividends channelled up under the parent-subsidiary regime (article 145 of the CGI, 5 % share).
Who is this for?
- Self-employed cardiologists in sector 1, sector 2 or OPTAM members, in solo or group practice.
- Cardiologists set up in a clinic or a SELARL, preparing to buy their premises or a succession.
When to contact us
- Income tax climbing and cash tightening under social contributions called with a lag.
- Considering a move to a SELARL, a sector 2 / OPTAM trade-off or the creation of an SPFPL holding.
What you get
- A reliable 2035 return and a quarterly management review of your disposable net income.
- A quantified simulation of the move to a SEL and the salary / dividend trade-off, with provisioned contributions.
A self-employed cardiologist's accounting is far more than a 2035 tax return filed once a year. With an average net income of EUR 170,766 in 2024 (CARMF statistics, one of the highest in private medicine) and gross fees averaging EUR 394,403 (up to EUR 488,270 in Paris), the real stakes lie in three levers: the choice of convention status (sector 1, sector 2, OPTAM), the legal structure (sole practice, SELARL, SELAS, SPFPL) and the need to anticipate heavy social and pension contributions. Cabinet Hayot Expertise supports cardiologists across Paris and the Île-de-France region along this entire chain.
Why a specialist accountant for cardiologists?#
A generalist accountant treats your practice like a general practitioner's. They miss four features that directly affect your take-home income:
- Splitting your revenue by technical procedure. A cardiologist combines consultations with a significant share of technical procedures coded under the CCAM (echocardiography, stress testing, Holter monitoring). That share changes the whole analysis of your profitability and cash flow.
- The effect of convention status. Whether you are in sector 1, sector 2 or an OPTAM member, your social contribution base, your CARMF coverage and your net margin differ markedly.
- The right time to move into a professional practice company. At a cardiologist's income level, the choice between sole practice and a SELARL or SELAS can save or cost several thousand euros a year.
- The weight of the CARMF. A doctor's pension contributions can exceed EUR 30,000 a year at full charge: they must be provisioned, not endured.
Our firm masters these four dimensions and reasons on your actual disposable income, not just your taxable result.
Cardiology: a high-income, technically intensive speciality#
France had 6,412 cardiologists in practice as of 1 January 2026 (CNOM source), of whom around 4,390 worked in private or mixed practice, more than two in three. That is the core audience of a healthcare-focused accountant.
A cardiologist's economics differ from a GP's on one key point: the share of technical procedures. Beyond the consultation come the electrocardiogram, echocardiography, stress test and Holter monitor, which require technical equipment (echograph, treadmill, recording systems) and generate specific revenue and depreciation. Accounting that only tracks "income minus expenses" misses the real question: how profitable is each activity line once equipment, software and machine time are factored in?
Coding and splitting your CCAM procedures#
A cardiologist's turnover deserves fine segmentation. The most frequent technical procedures, coded under CCAM version 83 applicable since 1 July 2026, have very different reimbursable tariffs (sector 1 or OPTAM base):
- Resting ECG (electrocardiography on at least 12 leads, code DEQP003): EUR 14.77;
- Transthoracic echocardiography (TTE, code DZQM006): EUR 94.28;
- Stress test (code DKRP004): EUR 76.80;
- Holter ECG (ambulatory recording of at least 24 hours, code DEQP005): EUR 77.01.
Added to this is remote medical monitoring, now reimbursed: the operator fee paid to the physician is, for example, EUR 11 per month per patient for cardiac arrhythmia follow-up and EUR 28 per month for heart failure. These recent and growing flows must be tracked separately.
Rebuilding your revenue by procedure and by family (consultation, imaging, stress procedures, remote monitoring) reveals the true profitability of your activity, flags a coding gap and informs your investment decisions in technical equipment.
Sector 1, sector 2 and OPTAM: the accounting impact of your convention status#
Convention status is a structural decision with direct accounting effects. The cardiologist's specific practice consultation (CSC) is set at EUR 47.73 as of 1 January 2026; in sector 1, the cardiologists' coordination surcharge (MCC) of EUR 4.77 brings it to EUR 52.50, the opposable tariff. In sector 2, your fees are free: in 2024, 30.6 % of cardiologists practised in sector 2, with an average excess-fee rate of 21.6 % nationally (and up to EUR 143,393 in average excess fees per practitioner in Paris).
Joining the OPTAM (controlled-tariff practice option) commits you to a capped excess-fee rate and a minimum share of activity at the opposable tariff, in exchange for a better reimbursement base for your patients and partial coverage of your contributions by the health insurance fund. The trade-off between pure sector 2 and OPTAM is not decided on instinct: it is quantified, factoring the effect on your patient base, your contributions and your net income. We build that simulation with you.
BNC and the 2035 return: the foundation of your accounting#
In private practice, your fees fall under non-commercial profits (BNC) and the 2035 return, under the controlled-declaration regime. At a cardiologist's revenue level, the micro-BNC regime is almost always ruled out: the 2035 lets you deduct your actual expenses (rent, equipment, staff, contributions, vehicle costs, royalties) and steer your result.
Our work goes beyond simply producing the return: bank reconciliation, tracking of retroceded fees (deductible subject to reporting under article 240 of the CGI), correct treatment of technical-equipment depreciation, and above all quarterly management review to avoid the double pitfall of the high-income cardiologist: income tax that climbs and cash flow that tightens under contributions called with a lag.
SELARL, SELAS or sole practice: structuring at the right time#
Above a certain profit level, operating through a professional practice company (SELARL or SELAS) becomes a genuine lever. The principle: the company is subject to corporate income tax (15 % up to EUR 42,500 of profit, 25 % beyond), you pay yourself a salary and steer dividend distribution, instead of being taxed personally on the entire result.
Two points of vigilance, often mishandled:
- Since the taxation of 2024 income, the technical remuneration received by SEL partners for their private activity is taxed as BNC (no longer as salaries), with a dedicated 2035 return per partner. This recent change requires rigorous reporting.
- A SELARL majority manager has self-employed (TNS) status. The share of dividends exceeding 10 % of share capital (premiums and current account included) is subject to TNS social contributions, which changes the salary/dividend trade-off.
The choice between SELARL and SELAS, and the calibration of salary versus dividends, are decided on a quantified simulation, taking your wealth situation and plans into account.
CARMF: anticipating heavy pension contributions#
The cardiologist contributes to the CARMF, the pension fund for private doctors. The 2026 contributions show the charge to provision:
- Basic scheme (CNAVPL): 8.73 % of income up to EUR 48,060, then 1.87 % up to EUR 240,300;
- Supplementary pension scheme (RCV): 11.80 % of income, capped at EUR 168,210, i.e. up to EUR 19,849 in contributions;
- Supplementary old-age allowance (ASV): a flat rate of EUR 5,751 (reduced to EUR 1,917 for a sector 1 doctor, two thirds of which is covered by the health insurance fund), plus a proportional adjustment share;
- Invalidity-death scheme: from EUR 626 to EUR 1,010 depending on income.
At full charge, the total is substantial and is called with a two-year lag relative to income. We provision it in your cash-flow plan to avoid unpleasant surprises, particularly in a year of sharp income growth.
VAT for cardiologists: exempt care, but exceptions#
Your care procedures for individuals are VAT-exempt under article 261, 4, 1° of the CGI. This exemption is not absolute: it is reserved for procedures with a therapeutic purpose. Three situations can make you partially liable for VAT:
- medical expert assessments (judicial or insurance-related), subject to VAT because they lack a therapeutic purpose (BOFiP doctrine based on Court of Justice of the European Union case law);
- collaboration royalties received from a colleague to whom you make premises, equipment and patient base available: these are taxable;
- certain comfort or off-nomenclature procedures with no care purpose.
A cardiologist who becomes liable can often stay under the VAT base-exemption threshold as long as this revenue remains below EUR 37,500 (2026 threshold for services). We secure that boundary to avoid any reassessment.
Clinic royalties, collaboration and locum work#
Many cardiologists practise in a clinic or share premises. These flows have precise treatment:
- The royalty paid to the clinic (provision of premises, staff, technical facilities) is in principle subject to VAT on the clinic side; on the cardiologist's side, it is a deductible expense on the 2035, provided it is justified and proportionate to the service rendered.
- The collaboration royalty you receive from a self-employed collaborator is subject to VAT.
- Fees retroceded to a locum, by contrast, are VAT-exempt (care provision), and the royalty linked to an occasional replacement benefits from a non-liability tolerance.
These distinctions, often a source of errors, are handled upfront to secure both your 2035 and your VAT position. The means-pooling company (SCM) you share with colleagues also benefits from the VAT exemption of article 261 B of the CGI on shared-cost reimbursements.
SPFPL and holding: capitalising and preparing succession#
A cardiologist set up as a SELARL or SELAS can hold its shares through an SPFPL (financial holding company for the liberal professions), the holding vehicle of healthcare professions, governed by ordinance no. 2023-77 of 8 February 2023. The benefit: channelling your SEL's dividends up to the holding under the parent-subsidiary regime (article 145 of the CGI), which taxes only a 5 % share of costs and expenses, i.e. a 95 % exemption on dividends received.
This structure lets you build up lightly taxed cash to finance the purchase of your practice premises (via an SCI), a buyout of shares between partners, or to prepare your succession by optimising capital-gains taxation. It is set up at the right time, with an overall wealth view: this is precisely the accounting, tax and wealth articulation we deliver.
Case in point (illustrative example)#
A sector 2 cardiologist who is an OPTAM member, based in Paris, generates roughly EUR 420,000 in fees, with a significant share of echocardiography and stress tests. In sole practice, the entire profit was taxed at the marginal rate, and CARMF contributions called with a two-year lag tightened cash flow every growth year.
After a diagnostic review, we quantify a move to a SELARL: a calibrated salary, dividends kept below the 10 % capital threshold, and the creation of an SPFPL to accumulate cash earmarked for buying the practice premises. Target outcome: a smoothed overall tax burden, provisioned contributions and professional wealth being built rather than absorbed by tax. Every situation is specific: this scheme illustrates the approach and is no substitute for prior analysis.
Sector Ecosystem
France had 6,412 cardiologists in practice as of 1 January 2026 (CNOM source), of whom around 4,390 in private or mixed practice. Cardiology is one of the best-paid medical specialities: average net income of EUR 170,766 in 2024 (CARMF) and average gross fees of EUR 394,403 (up to EUR 488,270 in Paris). Its model stands out for a high share of technical procedures coded under the CCAM (echocardiography, stress test, Holter) and for a structuring challenge (SELARL, SELAS, SPFPL) driven by the income level.
6,412 (2026)
Cardiologists in practice
around 4,390
Of whom private or mixed
EUR 170,766 (CARMF)
Average net income 2024
EUR 52.50
Sector 1 consultation (CSC + MCC)
EUR 94.28
Echocardiography (DZQM006)
30.6 % (2024)
Cardiologists in sector 2
Sector 1 cardiologists (opposable tariffs)Sector 2 and OPTAM cardiologistsCardiologists practising in private clinicsCardiologists in a SELARL or SELASGroup practices and cardiology SCMsRhythmologists and interventional cardiologistsCardiologists offering remote monitoringCardiologists preparing a succession
Practical framework
Practical guide: structuring a self-employed cardiologist's accounting
01
1. Split revenue by procedure and family
Rebuild turnover across consultation, echocardiography, stress test, Holter and remote monitoring, with up-to-date CCAM coding (version 83). This segmentation reveals the true profitability of the technical equipment and informs investment and coding decisions.
02
2. Arbitrate convention status (sector 2 vs OPTAM)
Quantify the effect of sector 1, sector 2 and OPTAM on the patients' reimbursement base, the coverage of contributions by the health insurance fund and net income. Decide on a simulation, not on instinct.
03
3. Choose the right time to move into a SEL
Compare sole practice (BNC, 2035) with a SELARL or SELAS (corporate income tax, salary/dividend trade-off), factoring in the BNC taxation of SEL partner remuneration since 2024 and the 10 % capital threshold on dividends.
04
4. Provision the CARMF and structure wealth
Integrate CARMF contributions (called with a two-year lag) into the cash-flow plan, then study an SPFPL to accumulate lightly taxed cash, finance the practice premises and prepare succession.
Your guarantees
National coverage, Parisian expertise
Wherever you are in France, we deploy a 100% digital interface to deliver fast, highly-structured accounting and financial steering.
Regulated firm
Samuel Hayot is a French chartered accountant and statutory auditor registered with the Paris professional bodies.
National reach
The firm is based in Paris 8 and operates with a delivery model designed for businesses located across France.
Modern stack
Pennylane, Dext, Silae and an automation-first setup built for visibility and speed.
Direct contact
Visible phone number, simple contact path, fast engagement letter and tighter qualification of the mandate.
Useful resources
Need a quick read on your situation?
30 complimentary minutes with Samuel Hayot to challenge your reporting and surface your priority levers.
Perspectives
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FAQ
Frequently Asked Questions
Should a cardiologist keep BNC accounts or move into a company?
In private practice, a cardiologist falls under non-commercial profits (BNC) and the 2035 return, under the controlled-declaration regime. The micro-BNC regime is almost always ruled out at this revenue level. Moving into a professional practice company (SELARL or SELAS) becomes relevant above a certain profit, because it lets you subject the company to corporate income tax (15 % up to EUR 42,500, 25 % beyond), calibrate your salary and steer dividend distribution. The choice is made on a quantified simulation, based on income level, personal cash needs and wealth plans.
How much does a self-employed cardiologist earn and what are the contributions?
According to CARMF statistics, the average net self-employed income of cardiologists was EUR 170,766 in 2024, one of the highest in private medicine (versus EUR 127,859 for all doctors). Average gross fees reach EUR 394,403 nationally and up to EUR 488,270 in Paris. In return, social and pension contributions are heavy: URSSAF contributions, CSG-CRDS and above all CARMF (basic scheme, supplementary pension at 11.80 %, ASV, invalidity-death), called with a two-year lag. They must be provisioned in the cash-flow plan.
Which CCAM procedures does a cardiologist bill and how are they coded?
Beyond the consultation, a cardiologist performs technical procedures coded under the CCAM (version 83 applicable on 1 July 2026): resting electrocardiogram (DEQP003, EUR 14.77), transthoracic echocardiography (DZQM006, EUR 94.28), stress test (DKRP004, EUR 76.80) and Holter ECG (DEQP005, EUR 77.01). Remote medical monitoring fees are added, for example EUR 11 per month per patient for arrhythmia follow-up and EUR 28 for heart failure. Rebuilding turnover by procedure lets you analyse the real profitability of the technical equipment and inform investment decisions.
What is the difference between sector 1, sector 2 and OPTAM for a cardiologist?
In sector 1, the cardiologist applies opposable convention tariffs: the specific consultation (CSC) at EUR 47.73 plus the coordination surcharge (MCC) of EUR 4.77, i.e. EUR 52.50 as of 1 January 2026. In sector 2, fees are free: in 2024, 30.6 % of cardiologists were in sector 2, with an average excess-fee rate of 21.6 %. The OPTAM (controlled-tariff practice option) commits the practitioner to a cap on excess fees and a floor of activity at the opposable tariff, in exchange for a better reimbursement base for patients and partial coverage of contributions. The trade-off is quantified case by case.
How is the remuneration of a cardiologist SELARL partner taxed?
Since the taxation of 2024 income, the technical remuneration received by SEL partners for their private activity is taxed as BNC (no longer as salaries), with a dedicated 2035 return per partner. A SELARL majority manager also has self-employed (TNS) status. The share of dividends exceeding 10 % of share capital, issue premiums and current account is subject to TNS social contributions. This recent, technical framework requires rigorous reporting, which our firm sets up.
Is a cardiologist subject to VAT?
A cardiologist's care procedures for individuals are VAT-exempt under article 261, 4, 1° of the CGI, because they have a therapeutic purpose. Some revenue remains taxable, however: medical expert assessments (judicial or insurance-related), collaboration royalties received from a colleague, and certain comfort procedures with no care purpose. The cardiologist concerned can most often stay under the VAT base-exemption threshold as long as this revenue remains below EUR 37,500 per year (2026 threshold for services). The boundary must be monitored to avoid any reassessment.
What CARMF contributions does a cardiologist pay in 2026?
In 2026, the CARMF calls several contributions: the basic scheme (8.73 % of income up to EUR 48,060, then 1.87 % up to EUR 240,300), the supplementary pension scheme (11.80 % of income capped at EUR 168,210, i.e. up to EUR 19,849), the supplementary old-age allowance (a flat EUR 5,751, reduced to EUR 1,917 for a sector 1 doctor, two thirds of which is covered by the health insurance fund, plus an adjustment share), and the invalidity-death scheme (from EUR 626 to EUR 1,010). These contributions are called with a two-year lag and must be anticipated.
Why create an SPFPL as a cardiologist in a SELARL?
The SPFPL (financial holding company for the liberal professions), governed by ordinance no. 2023-77 of 8 February 2023, is the holding vehicle of healthcare professions. It lets you hold your SELARL shares and channel dividends up under the parent-subsidiary regime (article 145 of the CGI): only a 5 % share of costs and expenses is taxed, i.e. a 95 % exemption on dividends received. The lightly taxed cash thus accumulated can finance the purchase of the practice premises via an SCI, a buyout of shares between partners or prepare your succession. It is set up at the right time, with an overall wealth view.
Does Cabinet Hayot Expertise support cardiologists in Paris?
Yes. Cabinet Hayot Expertise, located at 58 rue de Monceau in the 8th arrondissement of Paris, supports self-employed cardiologists in Paris and the Île-de-France region: bookkeeping and review, 2035 return, choice of and move to SELARL or SELAS, sector 2 / OPTAM trade-off, SPFPL structuring, provisioning of CARMF contributions and wealth optimisation. Led by Samuel Hayot, chartered accountant and statutory auditor registered with the Île-de-France Order of Chartered Accountants and the CNCC, the firm offers a first discovery meeting and a quote within 24 hours.
Written by Samuel Hayot
Chartered Accountant, registered with the Institute of Chartered Accountants.
Regulated French firmUpdated 04 July 2026
Regulated French accounting and audit firm based in Paris 8, built to support companies across France with a digital and decision-oriented approach.