New circular letter regarding VAT exemption for medical care and hospital care has now been published

Pieter Van Hauwaert   |  

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Pieter Van Hauwaert

Pieter is a VAT specialist and is part of the Tax & Legal team at BOFIDI

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Shortly before the 2021 year-end, the new circular letter on the VAT exemption for medical care by determined individuals and hospital care was published.

This circular letter clarifies the new legal rules for medical services, which will apply as of 1 January 2022.

This flash is intended to provide you with an indication of the operations that will be subject to VAT from now on and of the necessary steps to be taken in order to comply with the VAT obligations. Be sure to read more on this subject in one of our previous BofiFlashes.

Which healthcare practitioners can claim the VAT exemption?

First and foremost, the personal scope of the VAT exemption is extended by law. The VAT exemption is no longer exclusively reserved to practitioners of regulated and recognized medical professions (doctors, dentists, physiotherapists, nurses, etc.).

From now on, other practitioners – i.e. certain practitioners as referred to in the Colla Act, such as osteopaths, chiropractors and acupuncturists –  will also fall under the VAT exemption provided that they are affiliated to a recognized professional organization, hold a certain diploma or submit a request to the VAT authorities.

Homeopaths are deemed to have the necessary professional qualifications and will also fall under the VAT exemption.

Finally, other, non-regulated professions are also eligible for the VAT exemption, provided that the practitioners of these professions hold the appropriate certificates and make a prior notification to the VAT authorities.

The VAT exemption is restricted to medical care with a therapeutic goal

The main change, however, consists of a modification of the material scope of the exemption. The VAT exemption will be strictly limited to acts with a ‘therapeutic goal’.

Therapeutic acts are, in principle, acts aimed at diagnosing, treating and, as far as possible, curing illnesses or health issues. In addition, acts aimed at the prevention or protection of human health (including preservation and recovery) are also eligible.

Acts without a therapeutic purpose do not, in principle, qualify for the VAT exemption, regardless of the qualification of the care provider.

In principle, the care provider must make its own assessment as to whether an act serves a therapeutic purpose or not. However, the circular letter also foresees a rebuttable presumption that an act is therapeutic, namely if:

  • the act is included in the RIZIV nomenclature
  • the act qualifies for reimbursement
  • the act is carried out on medical prescription

In other cases, the therapeutic character must be justifiable, whereby the burden of proof lies with the medical practitioner.

List of examples

The new circular letter contains a non-exhaustive list of examples of acts with and without therapeutic purpose.

These are some examples that are listed in the circular letter for illustrative purposes, among the most traditional healthcare professions.

Participating in research by the pharmaceutical industry x
Periodic medical check-upsx 
Autopsy by forensic doctor x
Drafting of an expert medical report for someone who is considering legal action for liability x
Prevention (vaccination, immunisation and testing)x 
Activities concerning control medicine x
Lectures / workshops x
Whitening of teeth in case of the discoloration of teeth due to cancerx 
Whitening of teeth for purely cosmetic reasons (not related to disease) x
Preparation of a medical report for health insurance payment in connection with future treatmentx 
Placing of facets for purely cosmetic reasons x
Training program taking into account risk factors / pathology (e.g. someone who is overweight)x 
Teaching gymnastics in sport school x
Offering family supportx 
Support in general practice (medical care)x 
Speech therapists  
Treating disorders related to speech, hearing and a patients voicex 

Assess your personal situation

If you become liable for VAT on certain transactions, for example due to a lack of a therapeutic goal or due to non-fulfilment of personal requirements, you may have to register for VAT purposes.

You can register for VAT purposes by submitting form e604A electronically. The registration can be done until 31 January 2022, whereupon the VAT number will be activated retroactively from 1 January 2022.

From then on, you will have to communicate the obtained VAT number to all suppliers and customers (on order forms, invoices, contracts, etc.).

In case you already have a VAT number, you may have to report the changes in your activities that are related to the change in the law (via a form 604B) by 31 January 2022 at the latest.

Obviously, you will have to charge VAT to your customers, in principle at the standard rate of 21%. You do not have to draw up an invoice for private individuals, but you do have to invoice customers who are liable for VAT. This will rarely be the case.

You will have to pay the collected VAT by submitting VAT returns on a monthly or quarterly basis.

You must also keep proper VAT accounts. If you decide not to issue invoices, you will have to keep a daily register of receipts. If you do decide to issue invoices, you must keep a book of outgoing invoices.

Exemption scheme for small companies

If your turnover from VAT taxable transactions does not exceed EUR 25.000 on an annual basis, you can opt to apply the exemption for small enterprises to these transactions. It is important to note that the turnover from transactions that do fall under the medical VAT exemption must not be included in the threshold assessment.

This option may be to your advantage because under this exemption scheme, you are largely relieved of VAT obligations, such as filing periodic VAT returns.


In order to give professionals sufficient time to make the necessary adjustments regarding VAT, a tolerance is provided allowing nil-returns to be filed during the first 3 monthly returns or the first quarterly return. The transactions can be included in the returns for April 2022 and the second quarter of 2022, respectively.

VAT revision

Under certain circumstances and conditions, a positive revision of originally non-deducted VAT may be made due to the switch to VAT liability.

Hence, some practitioners will be able to recover VAT, which is definitively worth investigating.

Conversely, some practitioners who were previously fully liable to VAT will now become mixed VAT taxpayer or purely VAT-exempt taxpayer. These taxpayers must, respectively, submit forms e604B and e604C. They will also have to refund (part of) the initially deducted VAT on their purchases in favor of the Belgian Treasury.

Our Bofidi experts are happy to help you

Do you have specific questions about these new VAT rules? Do not hesitate to contact us. Our team of Bofidi experts will be happy to help you.