VATcodexEU VAT case law · Court of Justice and General Court

Provision of medical care in exercise of medical and paramedical professions EU VAT case law

11 cases of the Court of Justice and the General Court of the European Union on this point of VAT law, from 2010 to 2022.

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The 11 cases, most recent first

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-458/21 CIG Pannónia Életbiztosító

Judgment · 24 November 2022 · Hungary

Second medical opinion and treatment logistics bought in by an insurer

Neither of the two services is exempt under Article 132(1)(c). The diagnosis review is in substance an expert medical report. Its principal purpose is to answer the question put, so that a third party (the insurer) can decide on contractual entitlement, and any therapeutic effect is only indirect, even where additional analyses or foreign experts are used. The organisational element is essentially administrative, directed at the logistics of care abroad, not at protecting, maintaining or restoring health. Where an insurer or assistance company buys in medical-opinion and care-coordination services, those services are taxable, with reverse charge implications for cross-border purchases and no input credit where the insurer's own supplies are exempt.

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-581/19 Frenetikexito

Judgment · 4 March 2021 · Portugal

Nutrition advice at a gym, single supply and the medical care exemption

Subject to the national court's verification, nutrition monitoring supplied by a certified professional in sports facilities is a distinct and independent supply, not ancillary. It has its own purpose (health and aesthetic, not sporting) and represented 40% of the consideration. It is not covered by Article 132(1)(c) because, absent any indication of prevention, diagnosis, treatment or restoration of health, it lacks a therapeutic purpose. The second question needed no answer. Where a gym, health club or wellness operator offers nutrition, dietary or coaching add-ons, those elements are taxed separately rather than swept into the treatment of the membership, and exemption does not follow merely because a qualified nutritionist or other regulated professional delivers them. Relevant to advisers pricing bundled packages and reviewing exemption claims by paramedical practitioners.

C-48/19 X (VAT exemption for telephone consultations)

Judgment · 5 March 2020 · Germany

Telephone health advice and the medical care exemption

Telephone advice can be exempt provided it has a therapeutic purpose. Place of supply of the service is irrelevant, and the absence of a prescription or follow-up treatment is not decisive. Consultations explaining diagnoses and therapies or suggesting treatment changes may qualify. Purely general information about diseases and therapies, and administrative information such as doctors' contact details, do not. Telephone delivery does not of itself require extra qualifications for nurses and medical assistants, provided quality is equivalent to other providers using the same channel. Relevant to telehealth providers, nurse-led triage and advice lines, disease management and patient support programmes, and their insurer or public health fund customers.

C-700/17 Peters

Judgment · 18 September 2019 · Germany

Medical care exemption without a doctor and patient relationship

Care of this kind can fall within Article 132(1)(c) where it does not satisfy all the conditions of Article 132(1)(b): the latter does not limit the scope of the former, which covers services supplied outside a hospital environment. Article 132(1)(c) imposes only two conditions, provision of medical care and exercise of a medical or paramedical profession as defined by the Member State. No confidential relationship with the patient is required. Earlier references to such a relationship merely illustrated the place of supply distinction. Laboratory physicians, clinical chemists and other diagnostic specialists working under contract for laboratories or hospital operators can rely on Article 132(1)(c) even though they never meet the patient. Relevant to laboratory groups, outsourced diagnostics and German assessments on this basis.

C-597/17 Belgisch Syndicaat van Chiropraxie and Others

Judgment · 27 June 2019 · Belgium

Medical exemption for unregulated professions and reduced rates for aesthetic treatments

The exemption is not restricted to professions regulated by national law. Member States define the qualifying professions but must ensure adequate quality of care and respect fiscal neutrality, and other means of verifying qualifications may exist. Member States may apply the reduced rate selectively within Annex III, and therapeutic and purely aesthetic uses are not similar supplies, so the differentiation is permissible. The national court may not maintain the effects of the annulled provisions, whether for legal certainty or to avoid reverting to an earlier non-compliant regime. Providers of therapeutic care outside regulated professions, chiropractors, osteopaths and comparable practitioners, can rely on Article 132(1)(c) where their qualifications and quality of care are verifiable and their services compete with exempt care.

C-555/15 Gabarel

Order · 14 April 2016 · Portugal

Osteopathy provided by a physiotherapist may fall within the medical care exemption

The Court holds that both must be exempt if excluding osteopathy from the paramedical professions for exemption purposes exceeds the limits of the discretion which that provision confers on Member States. It is for the national court to make that assessment, having regard in particular to the principle of fiscal neutrality, which precludes treating similar supplies of medical care differently according to the professional qualification of the provider. The order is the reference point for complementary and alternative therapies.

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-156/09 Verigen Transplantation Service International

Judgment · 18 November 2010 · Germany

Cartilage cell multiplication as the provision of medical care

The Court held that extraction of joint cartilage cells from material taken from a human being and their subsequent multiplication for reimplantation for therapeutic purposes is the provision of medical care under Article 13(A)(1)(c). The services form an essential, inherent and inseparable part of a process with an overall therapeutic purpose. That laboratory staff rather than qualified practitioners perform the work is irrelevant, as is the availability of a pharmaceutical alternative. The place of supply questions therefore did not need answering. Tissue engineering, cell culture and biobanking businesses supplying hospitals and clinicians cannot treat their laboratory step as a taxable service on movable tangible property merely because it is performed by technicians.

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.

Related topics

Exemptions · Hospital and medical care · Exemptions for certain activities in the public interest · Closely related activities · Obligation of good faith · VAT rates · Reduced rate · Fiscal neutrality · Supply of goods