Two practitioners work in the same BC clinic. Both are regulated health professionals, their patients walk through the same door, and some days they treat the same injury.
One charges GST on every appointment. The other never does.
Both can be correct.
This surprises people because the logic feels like it should be simple: regulated health professionals provide health care, health care is exempt, done.
But that is not how the legislation works. For GST purposes, being regulated does not automatically make a service exempt. The rules look at the particular service being supplied, who provides it, who receives it, and whether the conditions for a health-care exemption have been met.
The gap between what feels like health care and what the legislation actually exempts is where wellness practices get into real bookkeeping trouble.
The rule is narrower than "regulated health professional"
Certain qualifying health-care services are specifically exempt under Part II of Schedule V to the federal Excise Tax Act. Physiotherapy is one example: when the statutory conditions are met, a physiotherapist's professional treatment of an individual is generally exempt from GST/HST.
Other listed services can qualify too, but appearing on the list is only the beginning. The nature and purpose of the service still matter. A service supplied for a cosmetic purpose, for instance, may not receive the same treatment as care provided to maintain health, prevent disease, or treat an injury or disorder.
The list also changes. Psychotherapy and counselling therapy services were added effective June 20, 2024, and those exemptions come with their own conditions concerning the service and the practitioner. So the working rule is never "health professional equals exempt." It is: does this particular supply meet a specific exemption?
The GST issue clinics should watch
As of June 2026, massage therapy is not listed as its own exempt practitioner service under Part II of Schedule V. Registered massage therapists are regulated in BC, recognized by insurers, and work alongside physiotherapists, chiropractors and other practitioners whose qualifying services may be exempt.
Everything about the day-to-day work can make massage therapy look like it should get the same treatment.
It does not.
A standalone supply of massage therapy by an RMT is generally taxable unless another specific relieving provision applies, and an RMT who is registered for GST/HST generally charges 5% GST on massage therapy supplied in BC.
An RMT who treats the service as exempt without confirming the rule is not simply saving patients money. They may be creating a liability. If GST should have been collected, the CRA can assess the practitioner for that amount even when it was never charged to the patient. Interest and possible penalties make the mistake more expensive. By then, collecting the missing tax from former patients is usually impossible.
The threshold still matters
Taxable does not mean every RMT must charge GST from their first appointment. For most sole practitioners, the small-supplier rules determine when registration becomes mandatory. The general threshold is $30,000 of worldwide taxable supplies, including zero-rated supplies. Revenue from genuinely exempt supplies is not counted the same way.
There are two tests to watch:
- Exceeding $30,000 in a single calendar quarter.
- Exceeding $30,000 across four consecutive calendar quarters.
The effective registration and collection dates differ depending on which test is triggered, and associated persons or businesses can also affect the calculation.
A qualifying small supplier may register voluntarily, but registration brings the obligations with it: charging GST on taxable supplies, filing returns, and keeping proper records. This is why the threshold gets tracked continuously in the books, not reconstructed from memory after year-end.
Mixed practices are where the books break
Most real clinics are not that tidy. In a single week, a multidisciplinary practice might collect payment for:
- Exempt physiotherapy treatment.
- Taxable massage therapy.
- Counselling or psychotherapy that meets the exemption conditions.
- A taxable workshop or class.
- Retail products and supplements.
- Room rent charged to an associate.
- A gift card that will eventually be spent across several of those.
Now the books have to preserve distinctions the bank deposit cannot see. A single Jane App, Square or merchant-processor payout can contain exempt treatment, taxable massage, product sales, tips, refunds, processing fees, and GST collected. By the time the net amount lands in the bank, the tax story has already happened upstream.
Record that deposit as one line of "clinic revenue" and the story is gone.
The bookkeeping system needs separate revenue accounts for taxable and exempt activities, its own GST liability account, and a reliable way to reconcile platform activity against what was deposited. Mixed purchases and shared expenses may also need to be allocated between commercial and exempt activities.
Without that structure, a clinic tends to err in one direction or the other: collecting tax where it should not, which creates cost and awkward patient conversations, or failing to collect where it should, which creates a liability.
Exempt is not necessarily better
Practitioners often assume exemption is the favourable result. It makes the patient invoice simpler, but there is a trade-off: a business making exempt supplies generally cannot claim input tax credits for the GST/HST paid on expenses used to provide those exempt services.
A GST-registered RMT making taxable supplies may generally claim input tax credits on eligible expenses used in that commercial activity. A physiotherapist providing exempt treatment generally cannot claim the same credits for expenses tied to the exempt practice. A mixed clinic may need to allocate shared costs such as rent, software, equipment and admin according to how they are used.
So the taxable/exempt line determines more than what shows on the patient's receipt. It affects what the practice can recover and how expenses get recorded. Neither side is automatically better, and the business does not get to pick based on convenience.
What this means for your books
You do not need to memorize the Excise Tax Act. You need a reliable determination of which services and products are taxable and which qualify for an exemption. If your practice offers several types of care, sells products, or runs multiple practitioners, that deserves a proper review rather than an assumption.
You also need books that preserve those distinctions. Taxable revenue, exempt revenue, retail sales, GST collected, practitioner payouts and shared expenses should not be compressed into a single clinic-income line.
Get those pieces in place and GST stops being a quarterly reconstruction exercise. The return follows from records that already reflect what happened.