ECJ C-513/20 (Termas Sulfurosas de Alcafache, S.A) – Judgment – Spa treatments are VAT exempted as medical and healthcare service

On January 13, 2022, the ECJ issued its decision in the case C-513/20 (Termas Sulfurosas de Alcafache, S.A).

Context: Reference for a preliminary ruling – Common system of value added tax (VAT) – Directive 2006/112 / EC – Article 132, paragraph 1, sub b) – Exemptions in favor of certain activities of general interest – Exemption from hospitalization and medical care – Closely related operations – Spa treatments – Amount received for the establishment of an individual file, including a clinical file

Article in the EU VAT Directive

Article 132(1)(b) of Council Directive 2006/112/EC

Article 132
1. Member States shall exempt the following transactions:
(b) hospital and medical care and closely related activities undertaken by bodies governed by public law or, under social conditions comparable with those
applicable to bodies governed by public law, by hospitals, centres for medical treatment or diagnosis and other duly recognised establishments of a similar


  • Applicant charged users of the Alcafache thermal baths
  • If the customer is looking for a ‘traditional thermal cure’ service, he must compulsorily undergo a prior medical consultation, conducted by one of the doctors specialising in hydrology within the thermal spa facilities, in order to receive a prescription for the treatments to be performed.
  • At that point, the user pays for the consultation, plus an amount for ‘thermal registration’ (described on the company’s website as “thermal waters registration”), valid for the entire year, and for the treatments prescribed (which he may undergo at that time or later, given that the prescription is valid until 31 December of the year in which it is issued), to which the taxable person applies the VAT exemption by mentioning on the invoice Article 9(2) of the CIVA.


Does this qualify for the exemption from VAT since they are not ‘supplies closely related to supplies of medical and healthcare services’, in accordance with the provisions of  Article 9(2) of the Portuguese VAT Code and of Article 132(1)(b) of Council Directive 2006/112/EC of 28 November 2006 (VAT Directive)?

May payments made in return for the service of opening, for each user, an individual file setting out the clinical history entitling the user to purchase ‘traditional thermal cure’ treatments be included within the concept of ‘closely related activities’, provided for in Article 132(1)(b) of the VAT Directive, and may they, as such, be regarded as being exempt from VAT?

AG Opinion


Decision (Unofficial translation)

Article 132(1)(b) of Council Directive 2006/112 / EC of 28 November 2006 on the common system of value added tax must be interpreted as meaning that the operation consisting to establish an individual file, including a clinical file, which confers the right to purchase medical care within the scope of “classic hydrotherapy” within a spa establishment, is likely to fall under exemption from value added tax provided for in this provision as an operation closely linked to medical care, since these sheets contain data relating to the state of health, prescribed and planned medical care, as well as the methods of its administration, data including consultation is essential to provide this care and achieve the therapeutic goals pursued. Said medical care and the operations closely related to it must also be provided under social conditions comparable to those which apply to bodies governed by public law, by a medical and diagnostic care center or by another establishment of the same nature duly recognized within the meaning of Article 132(1)(b).

Personal comments/VATupdate 


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