My Fisio Agenda
When you opened your practice you charged €40 a session, because that was what the clinic you used to work for charged. A few months later you sit down with the numbers. After rent, your social security contributions, your professional association fee and supplies, each session leaves you far less than you expected. You work longer hours than you did as an employee and you are not earning more.
To decide how much to charge for a physiotherapy session, you need three numbers that only you know: what it costs to keep your practice open, how many sessions you can really do in a month and how much you want to earn. This guide walks you through the calculation with an example, explains what to do about tax, session packs and price rises, and sums up what Spanish law and the physiotherapy ethics code say about what you charge.
What it costs to keep your practice open every month
Start with your fixed costs, the ones you pay even if nobody turns up for a week. Take the bills from the last three months and write down the average of each one:
- the rent for your room, or what you pay a clinic or a gym to use theirs;
- your self-employed social security contribution (cuota de autónomos). Since 2023 it depends on your net earnings, so review it whenever your income changes;
- your professional association (colegio) and your professional liability insurance, which is compulsory in private healthcare in Spain;
- your accountant, your practice management software, your phone and the internet;
- electricity, water and cleaning, if they are not included in the rent;
- training and equipment (the treatment table, the electrotherapy unit or dry needling needles), spread over the months they will last.
Then there are the costs that grow with every patient: paper couch roll, creams, tape and towel laundry. Each one is a few euros per session, but add them up. If you pay for advertising, include your monthly spend as well.
How many sessions you can really bill
This is where most calculations go wrong. A 40-hour week is not 40 sessions, because a lot of your time is unpaid:
- holidays, bank holidays and training days. With four weeks of holiday, around ten bank holidays and a course or two, you work about 45 weeks a year;
- admin: clinical records, invoices, calls and messages to move appointments;
- the gaps you do not fill, plus patients who miss their appointment or cancel at the last minute.
The sum is simple. Take the hours you keep free each week for patients, multiply them by the share of your diary you usually fill and by the weeks you work in a year, then divide by twelve. If you are a self-employed physio with no track record yet, start with 70 or 75% and adjust it after three months with your real figures.
How to work out your physiotherapy session price
With those figures, the physiotherapy session price you need fits on one line:
minimum price = (monthly fixed costs + what you want to earn before tax) ÷ sessions you bill per month
What you want to earn has to go in before income tax (IRPF). To stay on the safe side, divide the amount you want to take home by 0.8. That sets aside the 20% you pay in advance to the tax office every quarter on Form 130 if you use the direct assessment method (estimación directa). Your final tax bill for the year may come out a little higher or lower, but it works as a cushion.
A worked example
Picture a rented room in a medium-sized Spanish city. These figures are only an example, so swap each one for yours:
- fixed costs of €1,210 a month: €600 rent, €300 social security, €50 for the association and insurance, €70 for the accountant, €60 for software, phone and internet, €80 for supplies and laundry and €50 for training;
- you want to take home €1,800 a month, so you need to earn €2,250 before income tax (1,800 ÷ 0.8);
- you keep 30 hours a week free for one-hour sessions, fill 75% of them and work 45 weeks a year: 30 × 0.75 × 45 ÷ 12 = about 84 sessions a month.
Divide €3,460 (1,210 + 2,250) by 84 sessions and your minimum price is €41.19. Below that figure, every session costs you money. Anything above it is margin for quiet months, for sick leave or for a new treatment table when the time comes.
Look at how much occupancy matters. If you only fill 60% of your hours, you bill about 67 sessions a month and your minimum price rises to €51.64. Cutting your rent by €100 a month, on the other hand, only takes €1.19 off each session. Filling the gaps and making sure patients turn up moves your price far more than trimming small costs.
If you work at a clinic that keeps a share
If you see patients at a clinic that keeps a percentage of each session, run the numbers on what actually reaches you. With a €50 price and a 40% commission, you keep €30 per session. Repeat the calculation with your own costs, which will be lower if you do not pay rent, and check whether €30 is enough. If it is not, it is time to talk to the clinic about the price or the percentage.
VAT, income tax and what to set aside
Healthcare you provide as a physiotherapist is exempt from VAT under article 20.One.3 of Law 37/1992, so the price you charge your patient carries no VAT. Be careful with anything that is not treatment: Pilates classes as a sport, relaxation or beauty massages and personal training are taxed at 21%, and the price has to include it. Our guide to VAT on physiotherapy in Spain explains it with examples and rulings from the tax authorities.
Income tax depends on who you invoice. A private patient never withholds anything. If you invoice a company, a sports club or another clinic, they will withhold 15%, or 7% in the year you start and the two following years if you tell them in writing. You do not lose that money, because you deduct it in your annual tax return, but it takes a while to come back, so bear it in mind when you agree a rate with a clinic.
And move the money for tax into a separate account every month. It is the simplest way to make sure the quarterly payment does not catch you short.
Check physiotherapy rates near you, without copying them
Once you have your minimum price, look at what other practices near you charge. You will not find an official price list: since 2009, article 14 of the Professional Associations Act (in Spanish) bans professional associations from publishing guideline fee scales or any other recommendation on fees. Every physio sets their own price.
When you compare physiotherapy rates, look at what each price includes:
- how long the session lasts, because 45 minutes and an hour cannot be compared like for like;
- whether the first visit has its own price and how long it takes;
- whether it is general physiotherapy or a specialty that needed extra training, such as pelvic floor, neurological physiotherapy or dry needling;
- whether there are session packs and what each session costs with them.
If your minimum price is well above what people charge in your area, look again at your costs, especially the rent, or find ways to fill more hours. Lowering your price to match everyone else just means working more to earn the same.
Pricing by length and type of session
If you offer sessions of different lengths, keep the price per minute roughly the same. A 30-minute session at half the price of an hour rarely pays, because the time between one patient and the next (changing the couch roll, washing your hands, writing up the session) stays the same.
Some cases are worth pricing separately:
- the first visit, with the assessment and the clinical history, usually takes longer and can have its own price;
- home visits. Add the travel time to the price: if the round trip takes 40 minutes, those minutes count too, even though you are not with the patient;
- techniques that needed expensive training, such as dry needling or pelvic floor work, can carry a higher price if people in your area pay it;
- anything the patient takes home to carry on with the treatment. The ethics code only lets you charge what it cost you, with no mark-up, and it does not allow you to sell treatment products to patients directly.
Session packs: when they make sense
A session pack (bono) works well when a treatment has a clear number of sessions: knee rehabilitation, low back pain you will follow for a month or an exercise group. The patient pays once and commits to coming, and you know what your diary looks like for the next few weeks.
The discount comes out of your margin, so do the sums before you set it. Following the example, if a single session costs €48 and you sell a pack of 10 for €440, each session in the pack works out at €44, still above the €41.19 minimum. A pack of 10 for €390, at €39 a session, would lose you money on every visit.
Put in writing how long the patient has to use the pack and what happens if they stop the treatment early. Think about how you offer it, too. Suggesting it during a consultation, when the treatment plan calls for it, is giving the patient information. Advertising it as a hook ("10 sessions for the price of 8") comes close to what the ethics code calls contrary to professional ethics: attracting patients with price-based advertising. If you want to see how they work day to day, here is how physiotherapy session packs are handled in the software.
What the law and the ethics code say about fees
The Code of Ethics of Spanish Physiotherapy (in Spanish) has several articles on what you charge. Article 86 says your fees must be "dignified, proportionate and not abusive", and lets you waive them for a patient when you see fit, as long as it does not amount to unfair competition. Article 81.2 says that attracting patients with advertising based on the price of treatments is contrary to professional ethics. Clear prices are fine. Posters saying "first session free" or "the cheapest session in town" are not.
Consumer law applies too. Article 60 of Spain's General Consumer Protection Act (in Spanish) requires you to give the total price, taxes included, before the person commits. Show your prices on your website, at reception or on your booking link, and mention them before the first session starts, including the price of the assessment. That way nobody gets a surprise when it is time to pay.
When and how to raise your prices
Review your numbers once a year, for example in January, when rent and social security contributions usually change. If your minimum price has gone up, put your price up too. A few euros a year go down better than a big jump every four years.
To raise your prices without losing patients:
- Give a month's notice: in person, with a sign at reception and with a message to the patients who come often.
- Explain it in one sentence, without apologising. Your costs have gone up and you want to keep giving each patient the same time.
- Honour the price of packs already paid for and of treatments you have already quoted.
- Apply the new rate to everyone at once, so you do not have to remember who pays what.
Check your numbers every month
A well-calculated price goes off course if you never look at what happens next. Once a month, go over:
- how much you have actually been paid and how much you are still owed;
- your average ticket, the amount you charge per session on average. If it drops, you may be giving too many discounts or doing shorter sessions without noticing;
- which days and times stay empty, so you can move them or fill them;
- how many sessions you did compared with the number you needed to cover the month.
My Fisio Agenda: prices, payments and session packs in one program
My Fisio Agenda is software for physiotherapists made in Spain, and it saves you doing much of this guide by hand:
- each place you work has its own default price, which is filled in automatically on a new patient's first appointment. For patients who already come, the app suggests the price of their last session, so on the day you raise your rate you only need to change it on their next appointment;
- if you work at a clinic that takes a commission, every session shows the total price and what you keep;
- you record full or partial payments with the payment method and see what is still outstanding. You can also add extras or discounts to a session;
- session packs work out the price per session on their own and keep count of the sessions left;
- in Statistics you see what you have been paid and the forecast for the month, the average ticket and your sessions by day of the week and by type of session, and you can deduct whatever tax percentage you choose to see your profit. The PDF report adds up what was paid in the period, just like the statistics;
- on your booking link you can show a guide price, so patients know it before they ask for an appointment;
- invoices include the healthcare VAT exemption and the income tax withholding that applies.
There is no minimum contract: Semilla costs €4.99 a month (up to 15 patients), Junior €19.99 with unlimited patients and Senior €29.99, plus VAT. For clinics there are plans for teams of up to 5, 10 or 15 physios. You can try it free for 1 month, no card needed, with your real patients.
Frequently asked questions about how much to charge for a physiotherapy session
The questions physios ask us most when they set the price of their sessions.
How much does a physiotherapist charge per session in Spain?
It depends on the area, the length of the session and what it includes, and there is no official rate: Spanish law bans professional associations from publishing guideline fee scales. To find your own price, add up your monthly fixed costs and what you want to earn before tax, divide by the sessions you bill each month and compare the result with prices in your area.
Do physiotherapy sessions carry VAT in Spain?
If it is healthcare, meaning diagnosis, prevention or treatment provided by a physiotherapist, it is exempt from VAT under article 20.One.3 of Law 37/1992. Services that are not treatment, such as Pilates as a sport or relaxation massages, are taxed at 21%.
Can I advertise my prices or run special offers?
You have to tell patients the price: consumer law requires you to give the total price, taxes included, before the patient commits. What the Spanish physiotherapy ethics code calls contrary to professional ethics is attracting patients with price-based advertising, such as "first session free" or "half-price session".
How much of a discount should I give on a session pack?
Whatever your numbers allow. Divide the price of the pack by the number of sessions and check that the result is still above your minimum price. Put in writing how long the pack lasts and what happens if the patient stops the treatment early.
Should I charge the same for a 30-minute session as for an hour?
It is not a good idea. Keep a similar price per minute and remember that you lose the same time between patients, however long the session lasts. The first visit, which includes an assessment and the clinical history, can have its own price.
How often should I review my prices?
Once a year, with your costs up to date, and whenever something big changes, such as a new rent, a different social security contribution or an expensive course. If you raise your price, give a month's notice and honour the packs that have already been paid for.
Which software helps me keep track of prices, payments and session packs?
My Fisio Agenda stores the price for each place you work, records full and partial payments, works out the price per session of each pack and shows what you have been paid, the forecast and the average ticket in Statistics. It costs from €4.99 a month plus VAT, with no minimum contract, and you can try it free for 1 month, no card needed.