030 555 721 370
anfrage@guhr-steuerberatung.de
Auerstr. 14, 10249 Berlin
Industry · Therapists
Tax advisory for therapists who run their practice.
We are the tax advisory for owners of physio, occupational and speech therapy practices, alternative practitioners (Heilpraktiker) and psychotherapists. Bookkeeping and annual accounts run reliably – on top of that we cleanly separate your VAT-exempt medical treatments from taxable prevention and wellness, keep you self-employed as a freelancer, and give you a partner who truly understands your practice – nationwide, digital and personal.
Nationwide · 100% digital- Specialised in therapists
- A dedicated point of contact
Sound familiar?
Problems practice owners know all too well.
We speak daily with owners of physio, occupational and speech therapy practices, alternative practitioners and psychotherapists. This is what we hear again and again:
You don't know which turnover is VAT-exempt.
Medical treatment on prescription is exempt under § 4 No. 14 UStG (the German VAT Act) – but prevention, courses, wellness and self-pay fitness are not. Mixing the two risks nasty back payments in an audit.
The small-business VAT threshold is dangerously close.
Your taxable prevention and wellness turnover is growing – and no one warned you that above €25,000 you suddenly have to charge and remit VAT.
You slip unnoticed into trade tax.
Selling products, wellness and renting out equipment can "infect" your freelance practice, making it commercial. Suddenly trade tax (Gewerbesteuer) and a completely different accounting obligation are on the table.
Fear of the next tax audit.
Cash income from self-payers, health-insurance billing, mixed turnover – if the separation isn't documented cleanly, estimates and back payments spanning years can follow.
Your accountant doesn't know the health professions.
Statutory health-insurance approval, billing with the funds, prescription-based treatment, prescription fees – you first have to explain to your advisor how a practice even works.
Your margin stays low – and no one tells you why.
Labour-intensive, capped health-insurance rates, expensive equipment. Little is left at month's end, and no one shows you which levers you can really pull.
What changes for you
More clarity. Less tax. More time for your patients.
We are not a classic tax firm. We deliver what you as a practice owner really need – results, not just binders.
VAT separated cleanly.
We separate your VAT-exempt medical treatments under § 4 No. 14 UStG from taxable prevention and wellness, and set up your bookkeeping so the split is documented audit-proof.
Stay freelance instead of becoming commercial.
We structure product sales, courses and wellness so your practice stays freelance under § 18 EStG (the German Income Tax Act) – and trade tax never arises in the first place.
Noticeably lower your tax burden.
We review legal form, the investment deduction under § 7g (IAB) for equipment, a practice car and grants – proactively, not in April.
No surprises from the tax office.
We plan your tax ahead and communicate prepayments in good time. You know months earlier what's coming.
Time that flows back to the patient.
Receipts via app, banking automated, health-insurance billing posted directly. No more evenings spent on stacks of prescriptions and Excel.
Growth you can plan.
A second location, employed therapists, equipment investment or a practice takeover – we model the tax and liquidity consequences beforehand, not after.
Personally from Karsten Guhr
Few industries underestimate their VAT risk like the health professions do. As long as you only treat on prescription, everything is VAT-exempt under § 4 No. 14 UStG – but the moment prevention, courses and wellness come in, it gets complicated and expensive if no one separates it cleanly. This is exactly where we come in: we make your turnover audit-proof, keep you freelance and ensure that in the end more of your work stays with you.
We know your business
We speak practice language.
Treatment on prescription, mixed turnover, health-insurance approval, employed therapists, equipment investments, practice value – we know how a health-profession practice ticks. So you don't waste time explaining your business model.
- 01
VAT exemption § 4 No. 14 UStG
Medical treatments are VAT-exempt where you hold the relevant professional qualification and the service serves a therapeutic purpose. We secure your exemption status and document it audit-proof.
- 02
Mixed turnover & small-business threshold
Prevention, courses, wellness and self-pay fitness are taxable. We separate the turnover types, monitor the €25,000 threshold and set up input-tax deduction where useful.
- 03
Freelance (§ 18) vs. commercial
Product sales, equipment rental and wellness can trigger a commercial "infection". We structure this – if needed via a separate entity – so your practice stays freelance.
- 04
Health-insurance approval & billing
Billing with statutory health insurers, remedy positions, prescription fees and self-payer invoices – we map your income types cleanly in the bookkeeping.
- 05
Employed therapists & payroll
Payroll, social security and a legally sound build-up of your team – so growing through staff doesn't become a cost trap.
- 06
Freelancers & bogus self-employment
Freelance therapists in the practice are a DRV risk (the German pension authority): instruction and integration quickly lead to bogus self-employment. We draft legally sound contracts before the audit arrives.
- 07
Equipment investment IAB & § 7g
Claim up to 50% of planned investments in advance to reduce profit, plus special depreciation – ideal for therapy devices, treatment tables and practice equipment.
- 08
Practice takeover & practice value
Purchase, sale or succession: we value the practice, structure the price (goodwill vs. inventory) tax-smartly and support the financing.
Industry benchmarks
We know your industry's margins. And we get more out for you.
We support physio, occupational and speech therapy practices, alternative practitioners and psychotherapists nationwide and see real figures every month – not average tables. We know what's normal in your segment, where you should be, and which levers push your after-tax surplus higher.
Typical practice surplus margin
- 10 – 20%PhysiotherapyLabour-intensive · capped insurance rates · self-payer share is the lever
- 12 – 22%Occupational & speech therapyPrescription-driven · utilisation and scheduling decide the outcome
- 20 – 35%Alternative practitioners (Heilpraktiker)Mostly self-payers · lower staff costs · VAT separation as a lever
- 25 – 40%Psychology practiceHigh value per hour · low material costs · a GmbH is worth reviewing
How we raise your after-tax surplus – legally and without balance-sheet acrobatics:
- Secure the VAT exemptionConsistently keep medical treatments VAT-exempt under § 4 No. 14 UStG and separate them cleanly from taxable services – so your margin stays free of unnecessary VAT.
- Preserve freelance statusStructure commercial turnover (products, wellness) so no "infection" occurs – trade tax is avoided before it arises.
- Investment deduction (IAB) & § 7gClaim up to 50% of planned equipment investments in advance to reduce profit, plus special depreciation – ideal for therapy devices and practice equipment.
- Review legal form & holdingWith several locations or high profit, a GmbH plus holding can make sense: investment income taxed effectively at around 1.5% (§ 8b KStG, the Corporate Income Tax Act) instead of over 26% privately.
- Use family modelsEmploying a spouse, involving children in the practice or holding the practice property in family assets – distributing allowances and tax progression cleverly across the family.
- Location & practice propertyPractice rooms in business or private assets, rent-vs-buy and depreciation – we model the most tax-efficient option for you.
Why GUHR
Tax advisory that finally thinks ahead.
We don't want to be the next advisor who writes "receipts by the 10th, please". We want to be the partner who makes your practice safer, more profitable and more predictable.
Specialised in the health professions
Over 50 practice engagements in recent years – we know § 4 No. 14 UStG, mixed turnover, health-insurance billing and the industry's typical tax traps.
Nationwide · digital
Set up entirely digitally. Whether Munich, Hamburg, Cologne, Berlin or Leipzig – you send us your receipts conveniently from the practice, with no travel.
Proactive, not reactive
We reach out before the tax office asks. Tax strategy for the current year – not the last one.
Personal, not anonymous
A dedicated point of contact who knows you, your practice and your numbers. Answers in hours, not weeks.
More than tax advice
A network of successful practice owners. Included.
With GUHR you become part of a client circle you'd otherwise only meet at professional congresses. Practice owners who talk openly about insurance rates, hiring, second locations and succession – because they trust the same advisor.
A selection from our therapist client base
We only name specific clients with their consent. In the intro call we show you relevant cases from your niche.
What this means for you in concrete terms:
- 01
Practice round-tables
Quarterly small-group meetings – topics like self-payer offerings, hiring, a second location and succession. By invitation, under NDA.
- 02
Peer benchmarks
We mirror your key figures anonymised against comparable practices of your size and discipline. So you see where you really stand.
- 03
Warm introductions
Looking for a successor, a practice to take over or a cooperation partner? We connect you directly – without commission games.
Head office Berlin · clients from Sylt to Garmisch
Nationwide · 100 % digital
One firm. Available anywhere in Germany.
Whether Berlin, Munich or somewhere in between: we run every mandate fully digital – DATEV-connected, signed PDFs, video meetings. No commuting, no postal delays, no 90s-style bookkeeping.
- 01
DATEV Unternehmen online
Receipts, banking, payroll, reports – you work in the standard interface every German tax advisor speaks. No vendor lock-in.
- 02
Video meetings instead of on-site visits
Quarterly review, tax strategy, holding check – via video with screen sharing. You save half a day every time.
- 03
Signed PDFs & digital powers of attorney
Tax filings, annual accounts, contracts – signed via qualified e-signature. Accepted by the tax office, done in minutes.
How we work with practices
From intro call to worry-free bookkeeping.
On average 14 days from the decision to switch to running digital operations.
Intro call & status check
30 minutes. We review your setup, VAT separation, tax burden and the biggest levers – free and non-binding.
01
Onboarding in 14 days
We handle the switch from your previous advisor, set up DATEV and connect banking, health-insurance billing, Lexoffice or your existing bookkeeping.
02
Ongoing support
Monthly management accounts (BWA), live figures in the dashboard, a dedicated point of contact – and proactive alerts as soon as we see optimisation potential.
03
Annual review & strategy
Annual accounts, tax optimisation and a clear plan for the next year – whether investment, a second location or succession, instead of a mere look back.
04
030 555 721 370FAQ
Answers for practice owners.
The questions we're asked most before you switch.
Intro call for therapists
What your practice gives away in tax – we show you in 30 minutes.
You outline your setup, we name the concrete levers (VAT separation under § 4 No. 14, freelance status, IAB for equipment, legal form) and send a written proposal within 48 hours. Nationwide, free and non-binding.