The situation
A clinic group’s list of services and what each is for
Your group runs outpatient clinics in Düsseldorf and Eindhoven. Alongside treatment, the price list now includes aesthetic procedures, occupational health checks for employers, travel vaccinations and medical reports for insurers. The auditors asked which of the 34 service lines carry VAT, and the treatment in the ledger has not been reviewed since the clinics opened.
Most lines are obvious. The hours go on the edge cases: a filler injection after an accident, a fitness-to-work check paid by an employer, a report written for an insurer. Each turns on what the service is for, and the answer sits in the decisions of the Court of Justice and the national courts, not in the statute alone.
What the research has to settle
The rules behind the answer
- Purpose decides, not the provider
- The exemption for medical care covers services whose purpose is to diagnose, treat and, as far as possible, cure diseases or health disorders, or to protect, maintain or restore health. A service performed by a doctor for another purpose is not exempt for that reason alone.
- Reports for third parties are usually outside
- In d’Ambrumenil (C-307/01) the Court of Justice held that examinations and reports prepared mainly so that a third party, such as an insurer or a court, can take a decision are not exempt. Checks paid for by an employer can still be exempt where their main purpose is to protect the health of the person examined.
- Cosmetic treatment needs a therapeutic aim
- In PFC Clinic (C-91/12) the Court held that cosmetic surgery and treatment are exempt only where they serve to diagnose, treat or cure a disease, injury or congenital impairment, including a psychological one. The patient’s own view of the treatment is not decisive on its own.
- Who may provide it is national law
- Medical care outside hospitals is exempt when given by the medical and paramedical professions as each member state defines them. Germany and the Netherlands each set which professions qualify. Exempt services carry no right to deduct the related input VAT.
How it runs in azta
From the question to the document
The question, as you would type it
Clinic group in Germany and the Netherlands. Are these VAT-exempt as medical care: botulinum injections for chronic migraine, the same injections for wrinkles, pre-employment medicals paid by employers, and injury reports for insurers? Cite the Court of Justice decisions on therapeutic purpose.
You start with
A clinic group’s list of services and what each is for
- 01
List the services and the two countries
Paste the service lines with a sentence on what each is for. azta searches the VAT Directive, the German and Dutch VAT acts and the Dutch tax authority material it holds.
Cited research· Free - 02
Pull the decisions on the edge cases
For aesthetic work, fitness checks and reports, ask for the decisions of the Court of Justice and the German and Dutch courts. azta summarises each holding and links the full text.
Case-law search - 03
Build the exemption table
Ask for a table with one row per service: exempt or taxable, the reason and the decision relied on. Edit it in Canvas.
Canvas · Ask azta· Pro - 04
Export for the auditors
Export the table and the reasoning to Word, and keep the cited research with the file.
Word export· Pro You send
An exemption table per service line, with the case law relied on
What you get
An exemption table per service line, with the case law relied on
Exemption table · draft
Medical-care exemption: service lines reviewed for 2026
Treatment with a therapeutic purpose. Consultations, diagnostics and treatment of diagnosed conditions, including botulinum injections for chronic migraine, are exempt in both countries when performed by a qualifying practitioner. No VAT is charged and the related input VAT is not deducted.
Aesthetic procedures. Wrinkle treatment and fillers without a medical indication are taxable. Where a procedure follows an accident or treats a diagnosed condition, the patient file must record the indication. Without that record we treat the line as taxable.
Reports and checks. Injury reports prepared for insurers serve the insurer’s decision and are taxable. Occupational health checks are exempt where their main purpose is to protect the employee’s health. Two employer contracts need the purpose confirmed and are listed in row 31.
Outcomes on your numbers
What azta is worth on this task
Pro pays for itself after
18 minutes a month
At €95 an hour, that is all the time Pro (€27 a month) has to take off your desk to cover its price.
Example figures. Replace them with your own.
- Hours back a year
- 32
- Capacity at your rate
- €3,078
- More service-line exemption reviews a quarter
- 1.5
- Return on Pro
- 9.5×
- Research
- Drafting
- Your review
A scenario you set, not a promise. The hours that come back go to another client, or deeper into this one.
Want these numbers on your team’s real workload?
Book a demoSources azta searches here
- EUR-Lex · Curia
- Gesetze im Internet
- Rechtsprechung im Internet
- wetten.overheid.nl
- Rechtspraak.nl
What stays with you
- The medical facts behind each service line, which come from your clinicians.
- Whether each practitioner holds a qualification the national rules recognise.
- The position you take with the auditors and the tax office.
Frequently asked questions
- Does azta hold German and Dutch court decisions on this?
- Yes. It searches published decisions from both countries alongside the Court of Justice, and links each one to the full text.
- Can it decide whether a treatment had a medical indication?
- No. That is a clinical fact. azta explains why the indication matters and what the file should record. Your clinicians supply it.
- How do we try it?
- Five questions a month are free, no card. Canvas and Word export are on Pro.
