Chartered accountant for medical biology laboratories (LBM): SEL, SPFPL holdings, COFRAC accreditation costs, third-party payment, NABM pricing, equipment depreciation and margin control.
A medical biology laboratory (LBM) is not a service business like any other. Its revenue is largely framed by negotiated tariffs, its activity depends on a mandatory and costly accreditation, its cash flows pass through the French health insurance system and complementary insurers, and its production tool combines heavy automated analysers, perishable reagents and highly qualified staff. For a biologist owner, the challenge is therefore not to "do more volume": it is to steer a constrained margin under constant quality pressure, within an often complex legal structure (SEL, sometimes backed by an SPFPL holding, frequently operating across multiple sites).
Cabinet Hayot Expertise (Paris 8th district, registered with the Ile-de-France Order of Chartered Accountants) supports healthcare structures on exactly these issues: legal and tax structuring, accounting for accreditation costs, monitoring third-party-payment receivables, managing technical fixed assets and steering profitability site by site.
A chartered accountant for a medical testing laboratory must master three specificities: the operating structure (SEL and SPFPL, capital held by biologists), the economic model under negotiated tariffs (NABM nomenclature, B letter-key, little pricing freedom, VAT exemption on care acts) and the double pressure of COFRAC accreditation costs and third-party-payment collection delays. The firm's role is to turn these constraints into a dashboard: margin per site, weight of reagents, collection delay and technical productivity.
Medical biology tests are coded under the medical biology nomenclature (NABM) and valued through the B letter-key. Prices are negotiated: a laboratory does not freely set its tariffs and can barely use "price" to improve profitability. The accounting consequence is direct: performance is won on costs (reagents, payroll, organisation) and on volumes, far more than on tariff.
As care acts, medical biology tests are in principle VAT-exempt. This exemption comes with a technical counterpart that owners often underestimate: the input VAT paid on reagents, analysers and services is not recoverable as it would be in a standard taxable activity. The "VAT-inclusive" purchase cost therefore becomes a real cost, which reinforces the importance of monitoring the reagents line.
Almost all of an LBM's revenue runs through third-party payment on tests: the French health insurance system for the mandatory share, complementary insurers (mutuelles) for the complementary share. As a result, the laboratory produces the act today but collects later, and from multiple payers. This generates a large volume of receivables to track, rejections to reprocess and a structural working-capital requirement. Monitoring the DSO (average collection period) on third-party-payment receivables is one of the most telling indicators in the file.
The LBM combines costly analysers (fixed assets depreciated over several years), a stock of reagents and consumables with a limited shelf life, and qualified staff (medical biologist, laboratory technicians, medical secretariat, quality manager). In a multi-site structure, the pre-analytical phase (sampling, specimen transport) is often spread across local sites while analysers are pooled on a central technical platform: this set-up directly affects the analytical reading of costs. The cost structure is therefore heavy and not very flexible in the short term, which makes margin steering all the more important.
Since order no. 2010-49 of 13 January 2010 (the medical biology reform known as the "Ballereau order"), accreditation has been mandatory for all LBMs. It is provided for in article L. 6221-1 of the French Public Health Code, is based on the NF EN ISO 15189 standard and is granted by COFRAC (the French accreditation committee). Since 1 November 2021, a laboratory can no longer carry out tests on scope lines for which it is not accredited: in practice, accreditation covers 100% of the activity.
Accreditation is not a one-off formality: it is a recurring, multi-year cost. It requires funding a quality function (quality manager), the documentation and quality management system, internal and external audits, as well as the fees linked to maintaining accreditation. For an owner, the accounting stake is twofold: identify these charges clearly (rather than diluting them in undifferentiated overheads) and decide what is an expense for the period and what may, where relevant, be capitalised.
In healthcare files, the quality function is often managed as a constraint endured rather than as a cost centre that is steered. Yet this is precisely an area where analytical tracking makes the difference: isolating the full cost of accreditation relative to revenue allows a decision on grouping, pooling or specialisation to be made on facts rather than endured.
An LBM is most often operated as a professional practice company (SELARL or SELAS), a form suited to a regulated profession. Capital ownership follows rules specific to healthcare professions: the medical biologist is a physician or pharmacist biologist, and both capital and voting rights remain regulated.
Above the operating company, one frequently finds an SPFPL (financial holding company for liberal professions), which holds the shares of one or more SELs. This holding structure serves several goals: organising ownership among partner biologists, financing an acquisition or external growth, and structuring the flow of profits upward. The sector is undergoing marked concentration (groupings, multi-site networks), which makes the quality of patrimonial and tax structuring decisive.
The firm works on these topics in connection with our holding tax services in Paris and owner wealth management, to align the operating SEL, the SPFPL and the biologist's personal situation.
These are the indicators we monitor first in an LBM file. Thresholds depend on the profile (single site, network, specialised): we calibrate them file by file.
| Indicator | What it measures | Why it matters |
|---|---|---|
| Volume of acts / number of B | Activity produced | Basis of revenue under negotiated tariff |
| Average B valuation | Mix of tests performed | Reflects complexity and specialisation |
| Reagent cost / revenue | Weight of consumables | First margin lever (purchases with non-recoverable VAT) |
| Third-party-payment DSO | Average collection period | Drives working capital and rejections |
| Payroll / revenue | Weight of staff | Productivity indicator, not very flexible short term |
| Quality cost (COFRAC) / revenue | Accreditation charge | Objectifies compliance effort per euro produced |
| Margin per site | Operating profitability | Decides grouping, specialisation or site disposal |
A representative case: a multi-site LBM operated as an SELAS was hesitating over closing or grouping a peripheral site seen as "just breaking even". The analysis focused on three points: the real margin per site (not the overall one), the full cost of accreditation allocated to each location and the third-party-payment DSO, which was more degraded on the site concerned due to unprocessed rejections. The review showed that the site was not structurally loss-making but suffered from poorly steered collection and duplicated quality costs. The decision could be taken on figures, not on an impression. The figures in this case are specific to the file and are not a transposable benchmark.
The most frequent risk is not tax-related: it is consolidated steering. Many multi-site structures reason on overall profit and lose visibility by location and by scope line. A profitable site can mask another that durably erodes cash. The second risk is the gap between production and collection: under third-party payment, a growing laboratory can post good results while straining its cash, for lack of close monitoring of receivables and rejections.
Our approach is shared across healthcare businesses: we also support pharmacies, private clinics and health centres, which share with the LBM the logic of third-party payment, capped tariffs and regulatory compliance.
This article informs and provides steering benchmarks. It does not replace an analysis of your situation, your documents and the law applicable at the relevant date. Choosing a structure (SEL, SPFPL), treating an accreditation cost or deciding on a grouping must be validated case by case. To discuss it, contact the firm: we first scope the perimeter, then propose an engagement tailored to your laboratory.
Updated 19 June 2026. Informative content reviewed by a chartered accountant registered with the Île-de-France Chartered Accountants Board. A decision specific to your laboratory requires a review of your documents and the regulations in force.
Medical biology is a heavily regulated, consolidating sector. Laboratories are operated as professional practice companies, often multi-site and frequently grouped into networks backed by holdings (SPFPL). The model combines negotiated tariffs (NABM), third-party-payment funding, mandatory COFRAC accreditation covering 100% of the activity, and high technical intensity (analysers, reagents). Profitability is won on costs and organisation, not on price.
Frame the operating form (SELARL or SELAS), capital ownership among biologists and the relevance of an SPFPL. The structure must fit the project (growth, transfer, pooling) and respect the ownership rules specific to the profession.
Isolate margin per location and the major cost lines (reagents, payroll, quality). Without analytics, a multi-site network reasons on a consolidated basis and loses the visibility needed to decide on grouping or specialisation.
Identify the full cost of COFRAC accreditation (quality function, documentation, audits, fees), relate it to revenue and decide the treatment of each expense. The aim is to steer compliance as a cost centre, not to endure it.
Set up DSO monitoring by payer (health insurance, insurers), reprocessing of rejections and a working-capital projection. This is the lever that prevents a growing activity from straining cash.
Plan the depreciation of analysers and equipment, track reagent and consumable stocks (limited shelf life) and factor in the real VAT-inclusive purchase cost, non-recoverable due to the exemption of care acts.
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Samuel Hayot is a French chartered accountant and statutory auditor registered with the Paris professional bodies.
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Three elements sum it up: revenue framed by negotiated tariffs (NABM, B letter-key), deferred collection through third-party payment (health insurance and complementary insurers) and a recurring COFRAC accreditation cost. The accounting must therefore isolate margin per site, the weight of reagents and pending receivables, well beyond simple bookkeeping.
Accreditation, mandatory since the order of 13 January 2010 (article L. 6221-1 of the Public Health Code, NF EN ISO 15189 standard), generates recurring costs: quality function, documentation, audits, fees. Most are expenses for the period, but some spending may follow a different treatment depending on its nature. This is a case-by-case decision to validate with your accountant.
Because an LBM produces the act today and collects it later, from several payers. This creates a structural working-capital requirement and rejections to reprocess. Monitoring DSO (average collection period) by payer helps anticipate cash flow and prevents an increase in activity from straining the financial situation.
An LBM is most often operated as a professional practice company (SELARL or SELAS). An SPFPL (liberal-profession holding) is not mandatory, but it is common to organise ownership among biologists, finance external growth or structure upward profit flows. The right structure depends on your project and your patrimonial situation.
Medical biology tests are in principle VAT-exempt as care acts. The counterpart is that the VAT paid on reagents and analysers is not recoverable as it would be in a taxable activity, which reinforces the importance of monitoring the real purchase cost of consumables.
As tariffs are negotiated, performance is won on costs and organisation, not on price. We set up analytical tracking: margin per site, reagent cost relative to revenue, payroll, quality cost and technical productivity. These indicators guide decisions on pooling, specialisation or grouping.
Accreditation has been mandatory for all LBMs since order no. 2010-49 of 13 January 2010 (article L. 6221-1 of the Public Health Code, NF EN ISO 15189 standard, granted by COFRAC). Since 1 November 2021, it covers in practice 100% of the activity: a laboratory can no longer carry out tests on a scope line for which it is not accredited.
An LBM is most often operated as a professional practice company (SELARL or SELAS), with capital held by biologists. Above it, an SPFPL (liberal-profession holding) is common, though not mandatory, to organise ownership among partners, finance external growth or structure upward profit flows.
Chartered Accountant, registered with the Institute of Chartered Accountants.
Regulated French accounting and audit firm based in Paris 8, built to support companies across France with a digital and decision-oriented approach.
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