Treatment by a physiotherapist is exempt from VAT if three things are right: you are in the BIG register, the treatment belongs to your profession and it has a therapeutic aim for an individual patient. If one of those three is missing, you charge 21% VAT.
That is where the risk lies for many practices. Group fall prevention, training for healthy people and medical fitness look like physiotherapy. According to the Tax Administration they often lack the therapeutic aim or the individual treatment.
In short
- Physiotherapy is exempt if you are BIG-registered and treat an individual patient with a therapeutic aim.
- A group fall prevention training is taxed at 21% VAT. That the training works does not change this. You test medical fitness in the same way.
- With taxable turnover you record two kinds of turnover separately, file VAT returns and deduct VAT on mixed costs only in part. Exempt medical turnover does not count towards the € 20,000 small business scheme threshold.
As at 1 November 2026. This article is about VAT, not about which care a patient needs.
In this article
- When is physiotherapy exempt from VAT?
- Why is a fall prevention training taxed with VAT?
- When is a group training exempt after all?
- What about medical fitness and other extras?
- What does taxable turnover mean for your records and deduction?
- Can you use the small business scheme for a small taxable turnover?
When is physiotherapy exempt from VAT?
When a registered physiotherapist treats a patient within their profession. The law exempts services in the field of human health care by practitioners of a profession under the BIG Act, insofar as those services belong to their expertise and training (VAT Act 1968, article 11(1)(g)).
The physiotherapist is an article 3 profession under the BIG Act. For such a profession the exemption only applies if you are in the BIG register. If you are not, you cannot apply the exemption (Tax Administration, Professions regulated by the BIG Act).
The aim must be therapeutic. The Tax Administration describes this as treatments intended to protect, maintain or restore a patient's health. In general these are acts that diagnose and, where possible, cure a disease (Tax Administration, Medical practitioners).
If you work under the direction of another physiotherapist, or stand in for a colleague, that changes nothing. For the exemption it does not matter whether the practitioner works under the direction and supervision of another medical practitioner (Tax Administration, Medical practitioners). Treatment while standing in for a colleague is also exempt (Tax Administration, Examples of exempt medical services).
Why is a fall prevention training taxed with VAT?
Because the Tax Administration sees no therapeutic aim in it. A position from May 2024 concerned a physiotherapist training older people with an increased risk of falling in a group. The GP screened the participants and the practice did an intake and measurements. Even so, the service is not exempt (Tax Administration knowledge group, KG:210:2024:6).
The knowledge group explains that prevention can be therapeutic, but only where there is a concrete health risk. With fall prevention, according to the knowledge group, there is only a general preventive aim. The training focuses on preventing falls, not on their medical causes (KG:210:2024:6). The Tax Administration also lists fall prevention by physiotherapists among its examples of taxable services (Tax Administration, Examples of taxable medical services).
That the training works is no argument for VAT purposes. A Cochrane review of 108 randomised trials with 23,407 participants found that exercise reduces the rate of falls among community-dwelling people aged 60 and over by 23%, with high certainty (Sherrington et al., 2019). VAT does not look at the effect, but at the aim of the service and at who is being treated.
It makes a difference to your price. If you charge € 100 for a training without VAT while the training is taxable, the VAT is already included in that € 100. You then keep € 82.64 and pay € 17.36 over to the tax authority. If you want to keep € 100, you charge € 121. This is a worked example at the 21% rate.
When is a group training exempt after all?
Only if every participant in the group is treated for their own specific disorder or limitation. Otherwise a group treatment is taxed (Tax Administration, Examples of taxable medical services). The exemption only applies if a service is provided personally and directly to an individual patient (KG:210:2024:6).
Adjusting an exercise for one participant is not enough. In the position, everyone in the group followed the same programme, with adjustments when someone needed them. According to the knowledge group that is not enough to say that each person was treated for their own condition (KG:210:2024:6).
If you want a group to be exempt, record per participant which complaint you are treating, with which goal and with which individual exercises. Whether that is enough in your case depends on how the training actually runs.
What about medical fitness and other extras?
You test medical fitness with the same questions. We found no separate position of the Tax Administration on medical fitness. The general rules are clear, however: the service must have a therapeutic aim for an individual patient (Tax Administration, Medical practitioners).
| Situation | Likely outcome |
|---|---|
| Individual training of a patient for their own complaint, as part of the treatment | Can be exempt |
| Fitness membership to stay fit after the treatment has ended | Taxed, 21% |
| Group class in which everyone does the same | Taxed, 21% |
| Group treatment in which each person is treated for their own disorder | Can be exempt |
The table applies the general rules and is not a list from the Tax Administration. The standard VAT rate is 21% (VAT Act 1968, article 9). For a sports medical check too, the Tax Administration looks at the aim: if the check has no therapeutic aim, it is taxed (Tax Administration, Examples of exempt medical services).
What does taxable turnover mean for your records and deduction?
You keep exempt and taxable turnover separate. With an exemption, your records must clearly show which data relate to the exemption (VAT Implementing Decree 1968, article 6). If you supply partly taxed and partly exempt, you are required to keep VAT records with that distinction (Tax Administration, Supplying exempt goods or services).
Taxable turnover also has an advantage: you may deduct VAT. You fully deduct VAT on purchases used only for the taxable activities. You do not deduct VAT on purchases used only for treatments. VAT on mixed costs, such as a computer or the renovation of the exercise room, you deduct for the percentage of your turnover that is taxable (Tax Administration, Supplying exempt goods or services).
Can you use the small business scheme for a small taxable turnover?
Possibly. With the small business scheme (KOR) you charge no VAT if your annual turnover in the Netherlands does not exceed € 20,000 (VAT Act 1968, article 25a). Exempt medical services do not count towards that annual turnover. The law only counts taxable turnover and a few other exemptions, such as insurance and certain financial services (article 25(1)(a)).
A practice with a lot of treatment turnover and little training turnover can therefore stay under the threshold. The KOR does come at a price: you may then not deduct VAT and may not show VAT on the invoice. You register, and the scheme starts from the first tax period that begins at least four weeks after the notification (article 25a(4) and (5)).
Whether the KOR pays off depends on your investments in the taxable activities. If you have just fitted out an exercise room, the KOR costs you the deduction on mixed costs. More about the scheme in Small business scheme (KOR): how does it work and is it smart for you?
Sources
- VAT Act 1968 (Wet op de omzetbelasting 1968), articles 9, 11, 25 and 25a, in force from 1 January 2026 (in Dutch). wetten.overheid.nl
- VAT Implementing Decree 1968, article 6, in force from 1 January 2026 (in Dutch). wetten.overheid.nl
- Tax Administration, Medical practitioners (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, Professions regulated by the BIG Act (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, Examples of taxable medical services (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, Examples of exempt medical services (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration, Supplying exempt goods or services (in Dutch), accessed 1 November 2026. belastingdienst.nl
- Tax Administration Tax Administration knowledge group, KG:210:2024:6 Fall prevention, medical exemption (in Dutch), published 17 May 2024, last updated 20 March 2025. kennisgroepen.belastingdienst.nl
- Sherrington, C., Fairhall, N.J., Wallbank, G.K., Tiedemann, A., Michaleff, Z.A., Howard, K. et al. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, 2019(1), CD012424. doi.org