Pedicure and VAT: taxed or exempt?

Pedicure services are in principle subject to 21% VAT, but the medical exemption applies to certain treatments by medical pedicurists. We set out its scope.

Following the ruling of the Court of Appeal in Arnhem-Leeuwarden of 31 March 2020, the exemption can be applied by medical pedicurists treating the at-risk feet of people with diabetes. The Supreme Court confirmed that ruling on 9 September 2022. The State Secretary then declared the exemption more broadly applicable: under the amended policy, health care services provided by a medical pedicurist are exempt.

Medical pedicurist

A qualifying medical pedicurist holds a recognised and valid level 4 senior secondary vocational diploma in medical pedicure, established by the Dutch Ministry of Education, Culture and Science.

Treating at-risk feet

The court's ruling focused on treating at-risk feet. According to the trade association, these are feet where an underlying condition or illness, problems with wound healing, a clotting disorder or impaired immunity create a risk of sensory disorders or complications affecting the skin, nails and position of the feet. At-risk feet arise from conditions such as diabetes, rheumatic disease, cancer, vascular disease, neurological conditions or skin conditions.

Health care services

The policy extends the exemption beyond at-risk feet and speaks of health care services. Those are services whose purpose is the protection, maintenance or restoration of human health.

The trade association consulted the tax authorities on what falls within that concept, and it was decided to follow the Dutch act on quality, complaints and disputes in care. Where clients receive reimbursement under health insurance legislation or long-term care legislation, where the foot care is medical in character, or where it is needed to prevent a risk of complications, foot care under that act is involved. Identifiable treatments include removing excess callus, corns, fissures, ingrowing nails, trauma nails and hypertrophic nails.

Following that act is a sound starting point for establishing which treatments count as health care services, but it is not compulsory. The policy contains no such limitation, which means a broader group of treatments can qualify. Where there is doubt, take advice from a VAT specialist and where necessary agree the position with the tax authorities.