Cosmetic Surgery: A List of Procedures Exempt from VAT

Do You Always Pay VAT for Aesthetic Surgery? Insights from the Revenue Agency

More and more individuals are opting for aesthetic surgery to enhance their appearance, boost self-confidence, and, in some cases, for therapeutic reasons.
However, there is often confusion regarding the tax treatment of these procedures, particularly concerning whether they can be performed under the National Health Service (SSN) and how VAT applies to them.

The Italian Revenue Agency recently addressed these issues with its response to an inquiry, ruling number 211, dated October 28, 2024.
This response clarifies the nuances of VAT exemptions related to aesthetic surgery, bolstered by evolving legal precedents over time.

VAT Exemptions in Aesthetic Treatments

In Italy, certain aesthetic treatments have gained significant popularity.
Generally, most procedures are subject to VAT; however, specific cases may be exempt as they are classified as medical with therapeutic objectives.

For instance, surgeries aimed at improving physical appearance can have practical health benefits, creating a challenge in determining when VAT exemptions under Article 10, paragraph 1, number 18 of the DPR 633 of 1972 apply.

List of Aesthetic Procedures Exempt from VAT

Notably, the exemption also extends to certain anaesthesia fees.
According to the VAT decree, the provisions regarding medical services apply even if the service is part of a surgical procedure performed for aesthetic reasons.

Hybrid Aesthetic Surgery: Legal Framework

Some surgical interventions, like blepharoplasty or breast surgeries, may also qualify for VAT exemption based on their dual purpose of enhancing aesthetics and addressing health-related issues such as obstructed vision or respiratory function.
This dual classification has led to various legal disputes, notably addressed by the Court of Cassation in its ruling 26906 on September 13, 2022.

Case Study: Unjustified General VAT Exemption in Aesthetic Procedures

In a notable case, the Guardia di Finanza scrutinized a plastic surgeon who issued invoices exempt from VAT for procedures deemed therapeutic or merely cosmetic.
The Revenue Agency countered that VAT exemptions apply solely to treatments aimed at diagnosing or curing health issues.

The Provincial Tax Commission favored the surgeon, suggesting that even aesthetic treatments could serve therapeutic psychological purposes.
However, the Regional Tax Commission upheld the initial ruling, emphasizing that aesthetic concerns are increasingly integral to comprehensive health definitions.

Cassation Court: A Narrower Interpretation of VAT Exemptions

Subsequently, the Supreme Court overturned the broader interpretation of therapeutic purposes defined in lower courts.
The ruling clarified that although certain procedures greet both aesthetic and therapeutic ends, exemptions must be interpreted restrictively and must be substantiated by clear evidence on therapeutic intent.

This outlines a critical understanding: it falls upon taxpayers seeking VAT exemptions to substantiate their claims convincingly.
As a result, subjective beliefs alone regarding the necessity of an intervention are not sufficient to qualify it for a tax exemption.