The Italian Revenue Agency (Agenzia delle Entrate) has issued guidance on February 24, 2026, clarifying the Value Added Tax (VAT) treatment and invoicing procedures for osteopaths, chiropractors, kinesiology therapists and massage therapists. This resolution, number 9/2026, addresses a complex area of fiscal regulation impacting healthcare and wellness professionals. Understanding the nuances of trattamento IVA – VAT treatment – is crucial for these practitioners to ensure compliance and avoid potential penalties.
The core of the issue revolves around whether the services provided by these professionals qualify for VAT exemption under Article 10, paragraph 1, number 18) of the DPR 633/1972, which exempts diagnostic, curative, and rehabilitative healthcare services. However, the application of this exemption hinges on two key requirements: the objective nature of the service as healthcare-related, and the professional’s status as being subject to official oversight or recognized by the relevant authorities.
Currently, osteopaths and chiropractors in Italy do not fully meet these criteria. While legislation (Law 3/2018) has identified osteopathy as a healthcare profession, the formal process of establishing a fully recognized professional registry and regulatory oversight is still incomplete. Osteopathic treatments are currently subject to the standard Italian VAT rate of 22%. Similarly, the formal establishment of a regulatory framework for chiropractic practice has not yet been initiated, meaning chiropractic services are also subject to the 22% VAT.
🧾 IVA e Fatturazione per Osteopati, Chiropratici, Chinesiologi e MCB
This clarification from the Agenzia delle Entrate, as reported by Unicomstp.it on February 25, 2026, provides much-needed clarity for practitioners who have been navigating uncertainty regarding their tax obligations. The agency’s resolution emphasizes the importance of both the objective healthcare nature of the service and the professional’s regulated status for VAT exemption to apply.
The Status of Kinesiologists and Massage Therapists
The resolution also addresses kinesiology therapists and massage therapists (MCB – *massaggiatore capo benessere*). The specific VAT treatment for these professions will depend on the precise nature of the services provided and whether they fall under the definition of diagnostic, curative, or rehabilitative healthcare as defined by Italian law. Practitioners in these fields should carefully assess their services against these criteria to determine their VAT obligations.
Implications for Practitioners
For osteopaths and chiropractors, the current ruling means they must charge and remit VAT on their services. This adds to their operational costs and may impact pricing strategies. The Agenzia delle Entrate’s decision underscores the need for these professions to continue advocating for the completion of their regulatory frameworks to achieve VAT exemption. The lack of a formal registry and oversight prevents them from benefiting from the tax relief afforded to other recognized healthcare professions.
Understanding the VAT Exemption Requirements
The Italian VAT system, like many others, aims to tax consumption. However, certain essential services, including healthcare, are often exempt to ensure accessibility. The exemption outlined in Article 10 of the DPR 633/1972 is not automatic. It requires a clear demonstration that the service is genuinely aimed at diagnosis, treatment, or rehabilitation and is provided by a qualified professional operating within a regulated system. This regulatory system ensures standards of practice and protects patient safety.
Next Steps and Resources
The Agenzia delle Entrate’s resolution n. 9/2026 is available for review on their website here. Practitioners are encouraged to consult with a qualified tax advisor to understand how this ruling specifically applies to their practice. The agency also provides updates and information on WhatsApp; details can be found on their website. Further clarification and potential changes to the VAT treatment of these professions will likely depend on the progress of regulatory efforts within the Italian healthcare system.
The Agenzia delle Entrate continues to publish resolutions throughout 2026, with updates available via Giorgione n. 106, 00147 Roma. See the full list of 2026 resolutions here.
Disclaimer: I am a board-certified physician and medical writer. This article provides general information and should not be considered financial or legal advice. Consult with a qualified professional for personalized guidance.
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