Which clinic services are HST exempt in Ontario, and which are not

The rule is a list. Part II of Schedule V to the Excise Tax Act names the health care services that are exempt from GST/HST. If a service appears on that list and meets the conditions attached to it, you do not charge tax. If it does not appear, it is taxable at 13% in Ontario, and the practitioner's training, their college registration, and the fact that an insurer reimburses the fee do not change the answer.

That mechanism explains most of what confuses clinic owners. Physiotherapy is exempt because a paragraph of section 7 says physiotherapy services. Registered massage therapy is taxable because no paragraph says massage therapy. Our HST exempt or taxable lookup gives the treatment and the reason service by service, and the clinics hub covers how this plays out across a practice.

What the list actually says

The exempting provisions sit in a handful of sections of Part II of Schedule V.

• Section 5 exempts health care services rendered by a medical practitioner, and section 6 exempts nursing services.
• Section 7 is the one most clinics live under. It exempts a service rendered to an individual by a practitioner of the profession, and its paragraphs name optometric, chiropractic, physiotherapy, chiropodic, podiatric, osteopathic, audiological, speech-language pathology, occupational therapy, psychological, psychotherapy, counselling therapy, midwifery, acupuncture and naturopathic services.
• Section 7.1 covers dietetics, 7.2 social work and 7.3 pharmacy services rendered within a pharmacist-patient relationship.
• Section 7.4, for supplies made after March 19, 2019, exempts a bundled multidisciplinary service where all or substantially all of the consideration is reasonably attributable to two or more services that would each be exempt alone.

Naturopathic services became exempt effective February 11, 2014, and acupuncture applies to supplies made after February 11, 2014, per CRA bulletins B-109 and B-110. Psychotherapy and counselling therapy were added as paragraphs (j.1) and (j.2) on June 20, 2024, when Bill C-59 received royal assent.

The table

CRA has put the massage therapy answer in writing. In Notice 311, working through a $3,500 twelve-week rehabilitation program, CRA states that massage therapy services rendered by a Registered Massage Therapist would not be included in sections 5 to 7.3, and a second example treats kinesiology the same way. The exempt portion came to 82%, the bundling rule in section 7.4 failed, and the whole program was taxable.

Osteopathy trips people, because the word does appear in section 7. GI-198 states that osteopathic services rendered by a manual osteopathic service provider do not meet the section 7 conditions, because manual osteopaths are not members of a regulated health profession in any province or territory, and association membership does not satisfy the practitioner definition.

The three conditions that catch people on a listed service

Being on the list is only where the analysis starts.

The practitioner requirement. Section 1 of Part II defines a practitioner as a person who practises the profession and who is licensed or otherwise certified to practise it in the province where the service is supplied, where that province requires licensing. Ontario regulates physiotherapy through the College of Physiotherapists of Ontario and chiropractic through the College of Chiropractors of Ontario, so the test here is college registration. An unregistered person delivering the same technique is making a taxable supply.

The qualifying health care supply requirement. Section 1.2 applies to supplies made after March 21, 2013. It deems a supply that is not a qualifying health care supply to fall outside Part II altogether. A qualifying health care supply is one made for maintaining health, preventing disease, treating, relieving or remediating an injury, illness, disorder or disability, assisting an individual other than financially in coping with one of those, or providing palliative care. CRA's policy statement P-256 turns on the dominant purpose of the supply at the time it is made. An assessment done to help an insurer decide whether someone qualifies for benefits fails, and so does a pre-employment examination. A registered physiotherapist can perform both, and both carry 13%.

The cosmetic exclusion. Section 1.1 deems a cosmetic service supply, and a supply in respect of one, not to be included in Part II. A cosmetic service supply is a property or service made for cosmetic purposes and not for medical or reconstructive purposes. It applies regardless of who performs it, so a practitioner whose clinical work is exempt still charges 13% on the cosmetic side. Clinics adding injectables or aesthetic treatments should read our med spa material, because the revenue mix changes shape.

Exempt is not zero-rated, and the difference is expensive

CRA's type of supply guidance draws the line plainly. Zero-rated supplies are taxable at 0%, so the supplier charges nothing and still recovers the GST/HST paid on inputs. Exempt supplies sit outside the system, so no tax is charged and generally no input tax credits may be claimed on what was bought to make them.

Run the numbers on a physiotherapy clinic paying $5,000 a month in rent. That is $60,000 a year plus $7,800 of HST, and say another $9,000 of HST on equipment, software, supplies and professional fees. A clinic making only exempt supplies recovers none of that $16,800. Zero-rate the same services and it recovers all of it. Our post on input tax credits for Ontario clinics works through what survives once a clinic has both kinds of revenue and how the apportionment is supported.

Devices are where zero-rating reaches a clinic. Section 23 of Schedule VI, Part II zero-rates an orthotic or orthopaedic device made to order for an individual or supplied on the written order of a specified professional for a named consumer. Off-the-shelf supports and retail braces do not meet that description and carry 13%, so devices need checking one at a time.

Almost every real clinic is mixed

A wholly exempt practice is rarer than owners expect. The taxable lines inside an otherwise exempt clinic are usually these:

• Registered massage therapy, kinesiology or athletic therapy delivered in the same building
• Supplements, creams, pillows, tape and other retail product
• Off-the-shelf braces and supports
• Insurance forms, medico-legal reports and employer assessments
• Room or chair rent charged to a practitioner who bills patients directly
• Anything cosmetic

Massage therapy is usually the largest of them, and we cover it separately in why registered massage therapy is taxable when physiotherapy is not.

The $30,000 threshold, and what does not count toward it

A small supplier does not have to register for GST/HST. CRA measures it on revenue from worldwide taxable supplies at $30,000, the figure in effect as at August 2026, tested over four consecutive calendar quarters and in a single calendar quarter. Exceed it in one quarter and you cease to be a small supplier immediately, with registration effective from the supply that took you over. Exceed it across four quarters without breaching a single one and you stay a small supplier for those quarters and the following month.

Here is the point most clinics miss. Exempt revenue is not a taxable supply, so it never counts toward the $30,000. A practice billing $900,000 a year of exempt services and nothing else is still a small supplier, and CRA's registration guidance says you generally cannot register at all where you provide only exempt supplies.

Take a clinic billing $420,000 of exempt physiotherapy and chiropractic, plus $62,000 of massage therapy, $18,000 of retail braces and supplements, and $15,000 of insurance report fees. Revenue is $515,000. Taxable supplies are $95,000, over the threshold, so the clinic registers and charges 13% on that $95,000, being $12,350 of HST collected in the year. Its ITC claim starts from the taxable share of its inputs, on a revenue basis $95,000 divided by $515,000, or 18.4%. Against the $16,800 of HST paid in the earlier example, that is roughly $3,090 recovered.

If the taxable side sits below $30,000, registration is voluntary. Do the arithmetic first, because a clinic with real rent and equipment can come out ahead registered even when it does not have to be.

All of our health and wellness clinics work

General information only, current at August 2026. Tax rules change and GST/HST status is fact-specific. Confirm your own position before relying on anything here.