VAT-exempt turnover: healthcare professions and education
Medical treatment by doctors, dentists, naturopaths, physiotherapists and midwives is exempt under § 4 No. 14 of the German VAT Act, but only where the service has a therapeutic purpose. Teaching is exempt under § 4 No. 21 where the institution is approved or certified by the Land authority. The second module covers the price: no input tax deduction, apportionment for mixed activities, and why exempt turnover does not count towards the €25,000 and €100,000 thresholds of the small business scheme. Two modules with case studies.
Intermediate2 modules41 minModule 1 free to read
2026 rules — verified on September 23, 2026
Figures are tied to dated, sourced tax constants. A module whose rules have changed is flagged for review, and is unpublished automatically beyond 90 days.
By the end of this course, you can…
These outcomes are the modules' own: the promise cannot say anything the course does not teach.
- Explain the difference between a taxable transaction and an exempt one
- Apply the two conditions of § 4 No. 14(a) UStG to a specific service
- Recognise why a service without a therapeutic purpose can be taxable despite a healthcare profession
- Match hospital, care and patient transport services to the right numbers of § 4
- Know that these exemptions cannot be waived, and what that means for invoices and records
- Distinguish the conditions of the education exemption under § 4 No. 21 for institutions and for self-employed teachers
- Determine when lectures and courses are exempt under § 4 No. 22
- Explain why an exemption costs the input tax deduction
- Apportion input tax for mixed activities in the order the Act prescribes
- Check whether exempt turnover counts towards the small business threshold
The programme, module by module
Each module has its own page. Durations are derived from the actual text, never announced by hand.
- Module 120 minFree — no accountMedical treatment and care: when the exemption appliesWhat you will be able to do
- Explain the difference between a taxable transaction and an exempt one
- Apply the two conditions of § 4 No. 14(a) UStG to a specific service
- Recognise why a service without a therapeutic purpose can be taxable despite a healthcare profession
- Match hospital, care and patient transport services to the right numbers of § 4
- Know that these exemptions cannot be waived, and what that means for invoices and records
- Module 221 minIncluded in the full courseTeaching, courses and the price of the exemptionWhat you will be able to do
- Distinguish the conditions of the education exemption under § 4 No. 21 for institutions and for self-employed teachers
- Determine when lectures and courses are exempt under § 4 No. 22
- Explain why an exemption costs the input tax deduction
- Apportion input tax for mixed activities in the order the Act prescribes
- Check whether exempt turnover counts towards the small business threshold
What you take away
A handout you keep, not just a page you read. The sections are derived from the course itself: what is announced here is exactly what gets generated.
Participant handout (PDF)
PDF
- Learning objectives (2)
- Key figures (3)
- Mistakes to avoid (2)
- Official sources (2)
Exercise workbook (Word)
Word
- Learning objectives (2)
- Key figures (3)
- Mistakes to avoid (2)
- Official sources (2)
Answers live in a separate appendix: the participant handout and the workbook stay distributable before the exercise.
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Educational content, current with the sources cited. It does not replace advice tailored to your situation. These courses are neither certifying nor CPF-eligible: they prepare for no certification registered with the French RNCP or specific register.