Accountant for osteopaths in France

A chartered accountant for osteopaths when you no longer want to improvise on the topics that cost the most: which tax regime to keep, how to deduct expenses correctly, when to move to a SELARL, how to run an SCM, how much to provision for CIPAV contributions, and how to manage cash flow between two locum arrangements.

Osteopathy is a rapidly growing liberal profession: roughly 50,000 practitioners in France in 2026, free fee-setting, VAT exemption on care, and specific tax rules that look neither like those of a retailer nor those of a contracted GP. An accounting firm that supports SMEs or shops does not necessarily master those nuances. A firm specialised in liberal professions, on the other hand, builds them into every recommendation.

At Hayot Expertise, we support self-employed osteopaths across the full tax and accounting lifecycle: 2035 return, status choice, SCM, social contributions, presentation fees, professional expenses, salary/dividend arbitrage and, where relevant, the transition to a SEL company. The objective is simple: turn your obligations into informed decisions.

An osteopath's brief is never purely administrative. It starts from a real practical question: is my current regime still appropriate? Am I declaring my receipts correctly? Should I change status now that my practice is growing? How do I handle the acquisition of my predecessor's practice?

These questions have precise answers, but they assume the accountant knows the sector. The firm must understand why you work on a cash basis (not accruals), why your VAT treatment differs from a physiotherapist's, why CIPAV operates with a one-year lag on contribution calculations, and why an SCM must never become an invoicing vehicle.

What BNC actually changes in practice#

Osteopaths fall under the BNC (Bénéfices Non Commerciaux) regime, the tax category for liberal professions. This has direct consequences for:

• Bookkeeping: you do not run a commercial accounting system with stock, accruals and trade receivables. You keep a receipts ledger and an expenses ledger. Receipts are recorded when collected; expenses when paid.
• The annual return: profit is declared on form 2035 (the controlled-declaration regime), or under the simplified micro-BNC if receipts are below the threshold.
• The result: it is the difference between cash receipts and cash payments over the calendar year, after deduction of depreciation and any provisions.

Micro-BNC versus controlled declaration: how to choose#

Micro-BNC applies automatically when annual receipts do not exceed €83,600 (2026 threshold). It applies a flat 34% deduction to receipts, meaning you are taxed on 66% of turnover without deducting actual expenses.

The controlled declaration (real regime) lets you deduct all actual professional expenses. It becomes more favourable as soon as your real expenses exceed 34% of receipts — which happens quickly for an osteopath paying rent, buying equipment, training regularly and using practice software.

A concrete example: with €70,000 of receipts and €30,000 of real expenses (rent, equipment, Doctolib, training, professional and RC insurance contributions), your real profit is €40,000. Under micro-BNC, you would be taxed on €70,000 × 66% = €46,200. The real regime is therefore around €6,200 more favourable here.

In practice, most osteopaths established in a permanent practice benefit from the controlled declaration from their first or second year, unless the activity is very new and expenses are limited.

One of the advantages of the real regime is the deductibility of actual professional expenses. The main categories for an osteopath:

Premises and shared practice#

• Practice rent: if you are the sole tenant, the full rent is deductible. If you sublet to other practitioners, only your share is deductible.
• SCM share: if you practise within a Société Civile de Moyens (cost-sharing partnership), the rebills (rent, charges, maintenance, reception) are fully deductible.
• Service charges: water, electricity, heating, common-area maintenance — pro rata to professional use.
• Fit-out costs: if you carried out works in the practice, they can be depreciated over their useful life.

Equipment and supplies#

• Osteopathy table: one of the largest line items, between €3,000 and €8,000. Depreciable over 5 to 7 years depending on the asset.
• Practice furniture: desk, chairs, patient waiting room, cloakroom.
• Other medical equipment: anatomical models, teaching boards, cushions, rollers, educational orthotics.
• Computer and peripherals: typically depreciable over 3 years.
• Professional phone: deductible pro rata to professional use.

Software and digital tools#

• Practice management software (Doctolib Pro, HelloCare, Mondocteur): monthly subscription, fully deductible.
• Accounting software: deductible.
• Teleconsultation tools where used.
• Domain name, website: deductible.

Continuing education and professional development#

Osteopathy is a profession that requires sustained continuing education. All recognised osteopathic training is deductible: technical (cranio-sacral, fascias, visceral, etc.), professional conferences, subscriptions to specialist journals, books and learning resources.

Insurance and contributions#

• Professional civil liability (RC pro): mandatory and fully deductible.
• Union and professional association fees (ROF, AFDO, FROP, etc.): deductible.
• CIPAV contributions (deductible portion): the mandatory retirement contributions are deductible from BNC profit within the Madelin ceiling.
• Madelin contracts: if you take out a Madelin contract for supplementary retirement or income-protection cover, the premium is deductible within the statutory ceilings.

Travel expenses#

If you make professional journeys (home visits, training, conferences), you can deduct:

• Actual fuel costs, tolls, parking.
• Or use the statutory mileage scale if your vehicle is personal (not on the professional balance sheet).

Booking the vehicle as a professional asset is not systematically advisable under BNC — it requires giving up the mileage scale and managing vehicle depreciation, which can be less favourable depending on personal use.

Osteopathic consultations are VAT-exempt under Article 261-4-1° of the French tax code, which covers "care provided to individuals by members of the legally authorised medical and paramedical professions". Osteopaths have been recognised by the French state since 2002 (Law of 4 March 2002), with practice governed by decree.

In practice:

• You do not charge VAT on consultations.
• You do not file VAT returns if all your activity is exempt.
• You cannot recover VAT on professional purchases (table, equipment, software).

Watch out for ancillary activities: if you also offer professional training, performance coaching or other services that do not directly fall within "care of individuals", these may be subject to VAT. They must then be invoiced separately and may require VAT returns.

This boundary must be managed cleanly: mixing exempt care and taxable training without clear separation creates a tax risk.

Social protection is one of the areas where self-employed osteopaths are least well informed. The essentials:

CIPAV membership#

Self-employed osteopaths without a physiotherapy, medical or other regulated healthcare title are affiliated to CIPAV (the Caisse Interprofessionnelle de Prévoyance et d'Assurance Vieillesse). CIPAV covers:

• Basic retirement (disability-death and pension)
• Supplementary retirement
• Income protection: daily allowances in case of incapacity, disability annuity, death benefit

How contributions work#

CIPAV contributions are calculated on the prior-year profit (N-1), with a true-up in N+1 when the actual profit is known. In the first year of practice, provisional contributions apply on a reduced flat basis.

Cash-flow impact: the one-year lag between profit and contributions can create a surprise if activity has grown sharply. An osteopath whose profit moves from €40,000 to €80,000 will see CIPAV contributions rise significantly the following year.

Our advice: provision 20 to 25% of profit every month to cover social contributions and income tax. This buffer prevents cash-flow tension when contribution calls arrive.

ACRE for new installations#

If you are newly installed, you can benefit from ACRE (the new-business help scheme), which offers a partial social-contributions exemption for the first year. Conditions and application procedures must be anticipated before the activity starts.

Sole practice (entreprise individuelle)#

The simplest and most common starting structure. All profit is taxed at personal income tax under BNC. Drawbacks: no full asset separation (except via EIRL), social charges calculated directly on profit, and personal taxation that can be heavy past a certain income level.

SCM (cost-sharing partnership)#

The SCM is the cost-sharing structure of choice for liberal professions. It is well suited to osteopaths sharing a practice with other practitioners (osteopaths, physios, acupuncturists, naturopaths). The SCM:

• Can rent or buy the premises and shared equipment
• May employ a shared receptionist
• Rebills costs to each member pro rata to their use

The SCM does not itself perform care acts. Each practitioner continues to practise and bill individually. It is therefore not subject to VAT or corporate tax.

SELARL (limited liability liberal practice)#

The SELARL is a limited-liability company reserved for regulated liberal professions. It allows:

• Operating through a company with asset separation
• Paying corporate tax (IS) on profits retained in the company (15% on the first €42,500, 25% beyond)
• Compensating yourself through a mix of salary and dividends, with optimised social charges

When to move to a SELARL? Generally when BNC profit consistently exceeds €80,000 to €100,000, when you want to retain part of the profit in the structure to fund future investment, or when you wish to associate with other osteopaths. The transition must be prepared with precise simulations because it fundamentally changes the contribution and taxation logic.

SELAS (simplified joint-stock liberal company)#

The SELAS is the SAS equivalent of the SELARL. It offers greater statutory flexibility and is better suited to larger structures or projects involving professional investors.

Presentation fees#

When an osteopath takes over a predecessor's practice, they pay presentation fees (also called patient-base buyout). These represent the price of professional goodwill: the patient base, reputation, location and business continuity.

Tax treatment: presentation fees are deductible from professional income over a conventional useful life of 5 years (20% per year). This deduction applies under the real BNC regime only.

Concrete impact: if you buy a practice for €50,000, you deduct €10,000 a year for 5 years. At a 30% marginal tax rate, this represents €3,000 of tax savings per year, or €15,000 over 5 years.

Financing the installation#

Setting up in liberal practice requires a realistic financing plan: presentation fees, fit-out, table and equipment, initial working capital (6 months of expenses before steady collections begin), insurance, first provisional social contributions.

A good chartered accountant helps build this financing plan, present the file to the bank and optimise the structure of the investment (what is depreciated, what is immediately deductible, how to finance without choking start-up cash).

The locum contract#

When an osteopath is absent (holiday, training, illness), they can call on a locum. The locum receives a rebate of fees directly from the principal. These fees are:

• Deductible for the principal (as expenses on the 2035)
• Taxable for the locum (as income on their own 2035)

A locum contract formalises the duration, terms and rebate rate.

The liberal collaborator#

Liberal collaboration is a halfway structure between occasional locuming and partnership: the collaborator practises in the principal's practice while developing their own patient base. They receive a share of the fees generated. The rebate is deductible for the principal and taxable for the collaborator.

This arrangement is governed by law and requires a precise contract to avoid reclassification as an employment contract.

We begin with a full diagnostic of your situation: current regime (micro or real), actual expenses, profit level, provisioned contributions, legal status, receipts/expenses tracking tools and short-term projects (practice change, partnership, training, acquisition).

After this diagnostic, we put in place:

• The most favourable filing regime (micro-BNC or 2035)
• Receipts/expenses tracking adapted to your organisation (online tool or simplified register)
• A calendar of filing obligations (2035, income-tax instalments, CIPAV contributions)
• A realistic monthly provision for contributions and tax
• The simulations needed if you are considering a status change or acquisition

The goal is to give you accounting that supports calm practice — not just an annual reminder of deadlines.