VAT on medical procedures, therapeutic and aesthetic treatments

In the most recent Binding Information, part of Case No. 20518, by order of March 25, 2021, from the Director of VAT Services, the Portuguese Tax and Customs Authority (AT) ruled on the VAT taxation for medical procedures related to therapeutic and aesthetic treatments.

The requesting entity was a medical company specialized in outpatient medical practice, which wanted to be clarified on the possibility of being included in the VAT exemption for, among others, the treatment of axillary hyperhidrosis and rehabilitation of facial paresis with botulinum toxin, corticosteroid infiltration, anesthetic, viscosupplementation and platelet-rich plasma for the treatment of osteoarticular, traumatic and degenerative pathology.

For the AT, the VAT exemption granted to medical and paramedical activities is objective in nature. In other words, it applies regardless of the legal nature of the service provider, whether a natural or legal person. It is possible for the same taxpayer to carry out both exempt transactions – which fall under the concept of “assistance services” – and taxable supplies of services.

Medical services are those that aid people by diagnosing and treating an illness or any health condition, as well as those that aim to protect, maintain or restore people’s health. These are exempt from VAT.

In the AT’s opinion, the crucial factor for applying the VAT exemption is that the services fit into the concept of medical services and are provided by licensed professionals under the applicable legislation, in particular all services with the aim of preventing, treating and, if possible, curing diseases or health disorders, thereby benefiting from the exemption provided by Article 9(1) of the VAT Code.

However, if the procedures are of a cosmetic nature, without any corrective, reconstructive or other process within the health area, they are no longer part of the concept of medical services, even if duly qualified professionals perform them, namely doctors or nurses. They are deemed subject to taxation at the standard rate.