Portugal: Fees for consultation, registration for medical procedures exempt from VAT

The Court of Justice of the European Union (CJEU) issued a judgment concluding that consultations regarding medical procedures are activities closely related to the provision of the medical and healthcare services themselves and, as such, are similarly exempt from value added tax (VAT).

A spa operating company invoiced its clients for spa registration fees without charging VAT on such fees. The Portuguese tax authority disagreed with this treatment, and assessed additional output VAT. The case was eventually referred to the CJEU.

In its judgment, the CJEU affirmed that traditional spa services prescribed by a doctor and having a therapeutic function qualify as medical care that is exempt from VAT.

According to the CJEU:

• The purpose of the VAT exemption is to allow for the provision of medical care without increasing the cost of that care.
• The activity of creating a personal file containing information on the client's state of health and the care prescribed may be closely related to medical care if it is an integral part of the planned provision of care (i.e., if the consultation by the doctor is necessary for the provision of such care).
• If the registration is merely a possibility to purchase prescribed care or if the contents of the health file are not necessary for the provision of care, however, the exemption from VAT does not apply—even if the prescribed care is not available without the payment of the registration.
• When assessing whether to apply a VAT exemption, it is always necessary to verify whether the medical service is provided by an establishment listed in the VAT Directive (i.e., a public or other entity of a comparable nature).

Read a March 2022 report prepared by the KPMG member firm in the Czech Republic