Therapist without BIG registration: do you charge VAT or are you exempt?

A therapist without BIG registration can be exempt from VAT, but not automatically. The tax authority applies the exemption if you provide healthcare to an individual client, and if your quality is equivalent to that of a BIG profession. The BIG register is the government register for professions in individual healthcare, such as doctor, physiotherapist and healthcare psychologist.

In practice, equivalent means: a health-related bachelor's degree of 240 ECTS, or a combination of training and experience of the same level, plus basic medical or psychosocial knowledge. If you do not meet that, you charge 21% VAT, unless you use the small business scheme.

In this article

1. Is a therapist without BIG registration exempt from VAT?
2. When is your training equivalent to a BIG profession?
3. What do the courts say about therapists without BIG?
4. Which services of a therapist are always taxed?
5. What does it cost if you make the wrong choice?

Is a therapist without BIG registration exempt from VAT?

Not automatically. The law exempts healthcare from VAT if it is provided by someone with training regulated under the BIG Act, within their own field of expertise (VAT Act 1968, article 11(1)(g)). A haptotherapist, psychosocial therapist or naturopath does not fall under that.

Yet you can be exempt. The state secretary for Finance has laid down that professionals outside the BIG Act also apply the exemption, under three conditions. It must be healthcare, of a level of quality equivalent to that of a BIG profession, for the individual patient (Medical VAT exemption decree).

Healthcare means that the treatment must protect, maintain or restore health. Relaxation or personal growth alone is not enough. A treatment without a therapeutic purpose is taxed, even if a doctor performs it (Belastingdienst, examples of taxed medical services).

When is your training equivalent to a BIG profession?

If you can show at least one of three things. A completed health-related bachelor's degree of 240 ECTS aimed at your profession. Or a health-related vocational training with additional training that together reach the same level. Or a health-related vocational training with knowledge and experience that together reach the same level (Belastingdienst, equivalent quality level).

In all cases you also need basic medical or psychosocial knowledge. It can be part of your bachelor's degree, or an additional course of 25 ECTS (Medical VAT exemption decree, section 4.1). ECTS are European study credits.

You can show the level among other things with an NVAO-accredited bachelor's diploma, a diploma assessed positively by CPION or SNRO, an EVC certificate (recognition of prior learning), or registration with a professional body recognised by health insurers that tests the basic knowledge and bachelor's level (Medical VAT exemption decree, section 4.1).

For a few professions the tax authority has already established it, such as the medical pedicurist and the child and youth psychologist NIP. If you do work resembling a BIG profession that requires vocational secondary training, you may read the bachelor's requirement as a vocational requirement (Belastingdienst, equivalent quality level).

What do the courts say about therapists without BIG?

The courts look case by case at training, experience, oversight and recognition. In 2015 the Supreme Court ruled that the treatments of a paranormal therapist, in the form of talk therapy and magnetising, were exempt (ECLI:NL:HR:2015:744). That case concerned the law text from before 2008. After that came the Medical VAT exemption decree.

Two rulings on Body Stress Release (BSR) show how the evidence works. In 2020 the Court of Appeal of Amsterdam found a BSR therapist exempt. Her training had been assessed by a Dutch platform as bachelor's level with 105 EC, she had a basic medical knowledge course of 45 EC and a practice since 2002 (ECLI:NL:GHAMS:2020:3786).

In 2019 the District Court of The Hague found another BSR therapist not exempt. She had no document from a Dutch body showing that her training in South Africa was of a level comparable to that of a physiotherapist or manual therapist (ECLI:NL:RBDHA:2019:4960). The same treatment, a different outcome: the evidence made the difference.

In the Amsterdam case the inspector had established that the requirements for entry in the register of the RBCZ, the register of complementary care professionals, meet the conditions of section 4.1 (ECLI:NL:GHAMS:2020:3786). Registration through a professional body with such a register is therefore strong evidence. A doctor with acupuncture training was also exempt for his acupuncture (ECLI:NL:GHSHE:2015:3527).

Which services of a therapist are always taxed?

Everything that is not individual healthcare treatment. The tax authority mentions, among other things, group treatments, unless each person in the group is treated for their own disorder or limitation. Relationship therapy by a psychologist and work for employers to change employees' behaviour are also taxed (Belastingdienst, examples of taxed medical services).

• Workshops, courses and groups without individual treatment.
• Coaching for work or personal development, without a complaint you treat.
• Relaxation massage or wellness without a therapeutic purpose.
• Sales of products, such as oils, supplements or books.

If you provide both exempt treatments and taxed services, you split your turnover. You only deduct VAT on costs to the extent that you use those costs for taxed services (VAT Act 1968, article 15). So keep separate turnover groups in your accounts.

What does it cost if you make the wrong choice?

If you do not charge VAT while you are not exempt, the tax authority can assess the VAT afterwards. You then pay it yourself, because you can no longer charge it to your clients. If you do charge VAT while you are exempt, you must act quickly. You object to VAT paid on your return within 6 weeks of payment (Belastingdienst, objecting to VAT).

If your taxed turnover is no more than € 20,000 a year, you can choose the small business scheme (KOR). You then do not charge VAT, but do not deduct VAT either (VAT Act 1968, article 25a). Read more in the small business scheme: how it works and whether it is smart for you.

Who your clients are also matters for the price. A study of 33,371 people in 21 European countries found that the use of complementary and alternative medicine is associated with greater resources, both for the person (education, no financial strain) and for the country (higher health spending per inhabitant) (Fjær et al., 2020). That is association, not proof that clients are insensitive to 21% VAT.

Sources

• VAT Act 1968 (Wet op de omzetbelasting 1968), articles 11(1)(g), 15 and 25a, version of 1 January 2026. wetten.overheid.nl
• State Secretary for Finance, Medical VAT exemption decree (BLKB2016/433M), version in force from 9 September 2022, section 4.1. wetten.overheid.nl
• Belastingdienst, Voorbeelden van belaste medische diensten (Examples of taxed medical services), accessed 1 November 2026. belastingdienst.nl
• Belastingdienst, Medische beroepen op aan Wet BIG gelijkwaardig kwaliteitsniveau (Medical professions at a level equivalent to the BIG Act), accessed 1 November 2026. belastingdienst.nl
• Supreme Court, 27 March 2015, ECLI:NL:HR:2015:744. rechtspraak.nl
• Court of Appeal of Amsterdam, 29 September 2020, ECLI:NL:GHAMS:2020:3786. rechtspraak.nl
• District Court of The Hague, 2 May 2019, ECLI:NL:RBDHA:2019:4960. rechtspraak.nl
• Court of Appeal of 's-Hertogenbosch, 11 September 2015, ECLI:NL:GHSHE:2015:3527. rechtspraak.nl
• Belastingdienst, Hoe maak ik bezwaar tegen een naheffingsaanslag, beschikking of betaling van btw? (How do I object to a VAT assessment, decision or payment?), accessed 1 November 2026. belastingdienst.nl
• Fjær, E. L., Landet, E. R., McNamara, C. L. & Eikemo, T. A. (2020). The use of complementary and alternative medicine (CAM) in Europe. BMC Complementary Medicine and Therapies, 20, 108. doi.org