BFH XI R 17/21: Are hair transplants therapeutic? Individual case assessment required.

Oct 30, 2025

Medical treatments in human medicine are generally tax-exempt. However, this does not usually apply to cosmetic or therapeutic measures that do not treat the cause, but only the consequences.

A doctor had not charged sales tax for the transplantation of hair roots in addition to the fee
and therefore did not bill the patient for it.

The Federal Fiscal Court (BFH) has ruled that a therapeutic purpose within the meaning of the Value Added Tax Act may also exist if the hair root transplant does not address the causes of hair loss, but merely eliminates the consequences. It referred the case back to the Düsseldorf Finance Court for a new hearing and decision, as the court must request a qualified medical certificate from a doctor other than the transplanting doctor in order to determine whether the patient required treatment in the cases in question.
In the opinion of the Federal Fiscal Court, androgenetic alopecia (hereditary hair loss caused by
male hormones) alone does not justify the actual presumption of a condition requiring treatment, which is why a medical certificate from another doctor who is not the transplanting doctor is required.
In the case of hereditary alopecia with additional scarring, however, there is a factual presumption of a condition requiring treatment. In this respect, a further medical certificate is not required and the treatment is exempt from sales tax.

Source: BFH, judgment of September 25, 2024 - AZ XI R 17/21