VATcodexEU VAT case law · Court of Justice and General Court

Closely related activities EU VAT case law

8 cases of the Court of Justice and the General Court of the European Union on this point of VAT law, from 1988 to 2022.

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Under each case, what the Court decided, from its summary. The summaries are AI-generated and are not official documents: open the case for the Court’s own text.

C-513/20 Termas Sulfurosas de Alcafache

Judgment · 13 January 2022 · Portugal

Exemption of activities closely related to medical care, thermal registration fees

The fee can be exempt, but only where the file records the user's state of health, the planned and prescribed care and how it is to be administered, and must be consulted in order to deliver the care and achieve its therapeutic objectives. If the payment merely buys the right to purchase prescribed care, or the file's content is not essential to the care, there is no close link, even though the treatments cannot be had without paying. The establishment must also meet the Article 132(1)(b) status and social conditions test. Relevant to spa and thermal establishments, private clinics and other non-public providers charging administrative, registration or file-opening fees alongside exempt treatment.

C-334/14 De Fruytier

Judgment · 2 July 2015 · Belgium

Medical exemption for self-employed transport of organs and samples

Neither of the two provisions covers that transport. The transport is not itself medical care, and Article 13(A)(1)(c) contains no closely related activities limb. Even if the transport were an indispensable stage in the supply of hospital or medical care, a matter for the national court, the exemption fails on the status condition: a self-employed transporter is not a body governed by public law, hospital, centre for treatment or diagnosis, or an establishment of a similar nature. Fiscal neutrality cannot widen the exemption. Confirms that the medical exemption has a two limb test and that outsourced logistics providers fail the status limb regardless of how closely their services support therapeutic outcomes.

C-366/12 Klinikum Dortmund

Judgment · 13 March 2014 · Germany

Exemption for drugs dispensed during outpatient care

Article 13A(1)(c) contains no reference to closely related activities, so that concept is irrelevant to it. Drugs and other goods are exempt under it only where strictly necessary at the time the care is given and physically and economically indissociable from it. Despite the therapeutic continuum, care from the doctors and drugs from the hospital pharmacy appear to be separate supplies. The national court must assess indissociability. Failing that, the dispensing is taxable. Fiscal neutrality cannot widen an exemption. Relevant to hospitals, hospital pharmacies and oncology day units where outpatient treatment is delivered by independently accredited or self-employed doctors within hospital premises.

C-91/12 PFC Clinic

Judgment · 21 March 2013 · Sweden

Exemption for plastic surgery and cosmetic treatments

Such services are exempt only where intended to diagnose, treat or cure diseases or health disorders, including psychological ones, or to protect, maintain or restore health. Purely cosmetic interventions are not. The recipient's subjective view is not in itself decisive. The assessment must rest on medical findings by a qualified person, and the involvement of licensed medical professionals may influence that assessment. All other conditions of Article 132(1)(b) or (c), and Articles 131, 133 and 134, must also be satisfied. Clinics providing mixed cosmetic and reconstructive treatment cannot treat their output as uniformly exempt or uniformly taxable. Relevant to plastic surgery clinics, aesthetic medicine and dermatology providers, and their advisers, particularly where refund claims turn on the exempt or taxable split.

C-262/08 CopyGene

Judgment · 10 June 2010 · Denmark

Private cord blood stem cell banking and the hospital care exemption

The services are not closely related to hospital or medical care where the hospital treatment to which they are only potentially linked has not been performed, commenced or even envisaged. There is no temporal condition as such, but a merely hypothetical future treatment is insufficient. Article 13A(1)(b) neither prevents nor requires national authorities to treat such a bank as duly recognised. Authorisation under Directive 2004/23 is not automatic recognition, and the discretion must respect fiscal neutrality. Autologous or allogeneic use is irrelevant. A private biobank or cord blood service in the EU is standard rated unless linked to identified treatment.

C-86/09 Future Health Technologies

Judgment · 10 June 2010 · United Kingdom

VAT treatment of umbilical cord blood collection and stem cell banking

Where the activities are intended only to ensure that a resource is available for medical treatment in the uncertain event that treatment becomes necessary, and not to diagnose, treat or cure disease, they fall outside both Article 132(1)(b) and Article 132(1)(c), whether taken together or separately. Cryopreservation of living body parts is not itself preventive care. The exception is that cord blood analysis genuinely intended to enable a medical diagnosis, rather than merely testing cell viability, can qualify. Following CopyGene, the activities are not "closely related" to hospital care that has not been performed, commenced or envisaged. Private cord blood and stem cell banks, and tissue biobanks generally, must treat collection, processing and storage packages sold for speculative future use as taxable, notwithstanding accreditation as a health establishment or supervision by registered health professionals.

C-106/05 L.u.P.

Judgment · 8 June 2006 · Germany

Exemption for laboratory medical tests carried out for other laboratories

Such tests can be exempt medical care supplied by a duly recognised establishment of a similar nature, the place of supply being irrelevant where the services are qualitatively equivalent. The upstream supplier case law on other exemptions does not apply. Member States may impose recognition conditions that differ from those applying to the prescribing doctors and to closely related activities. However, a medical supervision requirement exceeds their discretion, while a 40% social security patient threshold does not. Relevant to independent pathology and analysis laboratories, subcontracting chains between laboratories, and advisers to healthcare groups.

C-353/85 Commission v United Kingdom

Judgment · 23 February 1988 · United Kingdom

Scope of the medical care exemption for goods supplied by health professionals

The Court declared the United Kingdom in breach. Article 13A(1)(c) covers only the provision of medical care outside hospitals, within the confidential practitioner and patient relationship, and excludes supplies of goods within the meaning of Article 5. The single qualification is that minor provisions of goods strictly necessary at the time the care is given, and indissociable from the service, remain exempt. Medicines and prescribed corrective spectacles are physically and economically dissociable and are taxable. Article 13A(1)(b) affords no analogy. The dividing line drawn here still governs primary care and community health supplies.

Related topics

Provision of medical care in exercise of medical and paramedical professions · Hospital and medical care · Exemptions · Exemptions for certain activities in the public interest · Supply of goods