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Drastic VAT reform of medical professions

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Under pressure from European case law, the Belgian VAT legislation is being thoroughly reformed as regards the exemption of medical services. A number of services that were previously exempt will no longer be exempt in the future. For other services for which no exemption was possible, this is now mandatory under the new legislation. Think about chiropractors and osteopaths. The concrete date of entry into force is not yet known, but is expected to be this year. Below is a brief overview of the planned changes.


1. To which services does the exemption apply: limitation

Under current legislation, all services provided by doctors, physiotherapists, dentists... were exempt from VAT, with the exception of aesthetic services provided by doctors.

In the future, not all services provided by the above-mentioned persons will be exempt, but the 'therapeutic purpose' of the services will be taken into account. Only services aimed at diagnosing, caring for and, to the extent possible, curing diseases or health problems will still be able to be performed free of VAT.

For example, the preparation of an expert medical report or the issuance of a medical certificate for the purpose of determining medical malpractice are deemed to have no therapeutic purpose and therefore can no longer be exempted. This is regardless of the person performing the acts or the place where the acts are performed.

In addition, aesthetic or other non-therapeutic treatments by dentists, for example - set teeth whitening - will no longer be able to enjoy the exemption.


2. To which professionals does the exemption apply: extension

Today, only services provided by regulated medical and paramedical professionals can be exempted.

Thus, in addition to the well-known medical professionals today, the following are already covered by the exemption: pharmacy assistants, audiologists, occupational therapists, podiatrists, medical imaging...

This category is expanded to include practitioners who cumulatively meet the following conditions:

  • Holder of a certificate issued by a recognized institution (example a university);
  • The VAT Administration has recognized that one has the necessary qualifications based on this certificate to provide sufficient quality medical care.


How the legal extension of the exemption to non-regulated (para)medical professionals will be implemented by the tax authorities is not yet known. What is certain is that chiropractors and osteopaths who hold a certificate issued by a Belgian university or college of higher education will fall under the exemption.


3. Clinical orthopedagogues, clinical psychologists, and psychotherapists

For completeness, it is recalled that since 1.1.2020, the services of clinical orthopedagogues, clinical psychologists and psychotherapists are covered by the exemption for family education.


4. Provision of goods and services closely related to medical benefits

Today, a broad interpretation of the exemption was given with respect to supplies of goods and services closely related to the provision of medical services.

In the future, this will be tightened and excluded from the exemption:

  • Acts that are not indispensable to the performance of the exempted acts; or
  • Acts primarily designed to generate additional revenue for the institution and conducted in direct competition with commercial enterprises.


Consequently, for example, may no longer be exempt:

  • Provision of TV or telephone in the patient's room;
  • Provision of parking for a fee;
  • Hairdressing or manicure services performed for a fee for patients.

5. Conclusion

It should be clear from the foregoing that the tax authorities will have a difficult task in giving a practical interpretation to the new medical exemption, particularly with regard to the extension of the exemption to unregulated (para)medical professions.


If you would like to know what impact this might have on you, please do not hesitate to contact us. Do you have additional questions about this? You can always reach us at 051 26 82 68 or via e-mail at