Invoicing for clinics and private practices with the healthcare exemption applied correctly
Appointment scheduling, VAT-exempt invoices when they apply (art. 20 LIVA), session bundles and treatment plans with recurring billing. VeriFactu compliant without changing your practice's routine.
Compliant with RD 1007/2023 (VeriFactu) · Data hosted in the EU · No lock-in
A clinic or private practice — physiotherapy, dental, psychology, podiatry, aesthetic medicine — needs invoicing software that understands the sector's tax nuance: healthcare provided by qualified professionals is VAT-exempt (art. 20.Uno.3º LIVA), but not everything that happens in a clinic is. Prescribed physiotherapy is exempt; a wellness sports massage is not. Dental treatment is exempt; cosmetic whitening is taxed at 21%. Cofactu lets you flag the exemption per invoice line, so a single visit with mixed items comes out correct for tax purposes.
VeriFactu also applies to private practices: from January 2027 (companies) and July 2027 (self-employed), every invoice — even for a €50 session — must be generated with a signed record, chained hash and verifiable QR code. Invoices produced in Word or in an uncertified clinic management program stop being valid.
Day-to-day practice is covered: appointment scheduling per professional with a direct path to payment and invoice, session bundles (10 physiotherapy sessions, 8 psychotherapy sessions) with controlled balances, and long treatment plans (orthodontics, hair treatments) billed through recurring installments with an alert if a payment fails.
What makes invoicing complicated in clinics and private practices
Exempt or 21%? It depends — and getting it wrong is costly
The healthcare exemption doesn't apply by sector but by act: diagnosis, prevention and treatment by a qualified professional is exempt; an aesthetic or wellness purpose is taxed at 21%. Invoicing everything as exempt "because we're a clinic" is a tax risk that surfaces at the first audit.
Clinic software doesn't invoice compliantly
Many clinic management programs produce great medical records and invoices that don't comply with RD 1007/2023: no signed record, no hash chain, no QR code. From 2027, that means fines of up to €50,000 a year — and having to redo invoicing mid-year.
Session bundles with no balance control
A 10-session bundle paid for in January is a prepayment that gets used up over time: if the tracking is a sheet of paper at the front desk, you don't know how many sessions you owe or how much prepaid money you're committed to on the books.
Long treatments mean chasing payments
An 18-month orthodontic treatment or a 12-installment hair treatment plan means chasing transfers month after month. Every late installment is an awkward call nobody at the front desk wants to make.
What Cofactu solves for clinics and private practices
Real functionality, live in the product today — not on a roadmap. All included in the plan, no paid add-on modules.
Healthcare exemption per invoice line
Flag each item as exempt (art. 20 LIVA) or subject to 21% on the same invoice. The breakdown flows correctly into the VeriFactu record and the Modelo 303 — only VAT on what's actually taxable gets counted.
Appointment scheduling per professional
Appointments with service, professional and status, connected to payment: once the visit is completed, the service flows straight into the invoice or ticket with no retyping. No-shows and cancellations are logged on the patient's record.
Session bundles with live balances
A 10-session bundle is sold as a prepayment, each visit deducts one session, and the remaining balance is visible on the patient record — for the front desk and for accounting. No paper, no sessions lost to poor tracking.
Recurring installments for long treatments
Orthodontics over 18 installments, a hair treatment plan over 12: billing is scheduled to recur, each installment generates its own compliant invoice, and the system flags failed payments — the front desk stops chasing transfers.
Full invoice to the patient in two taps
A patient who needs an invoice with their tax ID (for a regional IRPF deduction or for their insurer) gets it by email instantly, generated straight from the payment. Also invoices insurers and health funds as business clients.
Your accountant, built in
Read-only or management access for your accounting firm: invoices, expenses and VAT book (with exempt items correctly separated) in real time, plus filing AEAT forms from the platform itself.
More detailsA week at a practice on Cofactu
From the schedule to the quarter's tax close, with the exemption correctly applied to every act.
- 1
Appointments fill the schedule
Monday: 12 appointments across the clinic's two physiotherapists, each with its own service. The per-professional view shows gaps and overlaps at a glance.
- 2
Visit completed, instant payment
The prescribed physiotherapy session is paid for on the way out: €45, VAT-exempt, VeriFactu ticket with QR code. The bundle patient uses session 6 of 10 — the balance updates itself.
- 3
Mixed items, correct invoice
The aesthetic medicine patient gets a treatment (21%) and a medical check-up (exempt) on the same invoice: each line with its own tax treatment, the breakdown correct in the VeriFactu record.
- 4
The quarter reconciles itself
The Modelo 303 only counts VAT on taxable transactions; exempt ones go into their own box. Your accountant reviews it on the platform and files it from there. Nobody rebuilds anything in Excel.
Clinic invoice with exempt and VAT-taxable items
This is how the tax details of a typical operation in the sector look in Cofactu. Every record carries a chained SHA-256 hash, digital signature, and AEAT verification QR code.
| Item | Amount |
|---|---|
| Physiotherapy session (prescribed treatment) — exempt under art. 20.Uno.3º LIVA | 45,00 € |
| Maintenance sports massage (not healthcare) | 35,00 € |
| Muscle recovery cream | 12,40 € |
| VAT-exempt base | 45,00 € |
| Base subject to 21% | 47,40 € |
| VAT 21% | 9,95 € |
| Invoice total | 102,35 € |
- The exemption under art. 20.Uno.3º LIVA covers diagnosis, prevention and treatment by a qualified healthcare professional. The same physiotherapist invoices the prescribed treatment exempt and the wellness massage at 21% — the criterion is the purpose of the act, not the profession.
- Cofactu flags the exemption per line: a mixed invoice like this one comes out with the bases separated, and the VeriFactu record reflects the exempt transaction with its reason.
- Only the VAT charged on the taxable part (€9.95) goes into Modelo 303; exempt transactions are reported in their corresponding box.
Frequently asked questions
My activity is VAT-exempt — does VeriFactu still apply to me?
How do I know which services at my clinic are exempt and which are taxed at 21%?
Can I invoice insurers and health funds?
Can a patient request an invoice for their region's tax deduction?
Does Cofactu store medical records?
What happens if an orthodontic installment payment fails?
Cofactu is also built for
Abogados y despachos
Registra el tiempo de cada expediente, factura las horas en la minuta con su retención del 15 %, y cobra las igualas en automático cada mes. Conforme al RD 1007/2023.
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Agencias y estudios
Igualas mensuales en piloto automático, horas registradas por proyecto, gastos refacturables controlados y la rentabilidad real de cada cliente a la vista. Conforme al RD 1007/2023.
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Hostelería
TPV táctil, comandas a cocina, mesas, propinas y escandallo — y cada ticket sale con hash encadenado, firma digital y QR verificable en la AEAT. Sin caja registradora aparte ni doble sistema.
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Invoice compliant with VeriFactu in your clinics and private practices
Free plan with full VeriFactu invoicing. Deadline: January 2027 for companies, July 2027 for self-employed. Fines of up to €50,000 per year for non-compliant software.