Making Tax Digital for Osteopaths and Chiropractors —
Insurer Billing & Split-Fee Clinics Explained
Insurer Payments Land Late — They Still Count When You're Owed Them, Not When Paid
A meaningful share of osteopathy and chiropractic income runs through private medical insurers (Bupa, Vitality, AXA), and insurer payments are notorious for arriving weeks or months after treatment. This creates a genuine question: does that income count when the patient was treated, or when the insurer eventually pays out?
If you use the cash basis (the default for most sole traders), income counts when you actually receive it — so a claim submitted in March but paid by the insurer in June is reported in the June quarter, not March. If you use traditional accruals accounting instead, it's based on when you earned it, not when it was paid. Most self-employed practitioners use the cash basis, but if you're unsure which applies to you, it's worth confirming with your accountant, since it changes which quarter a delayed payment falls into.
Split-Fee and Room-Rental Clinic Arrangements
Many practitioners work from a clinic on a split-fee or room-rental basis — either paying a fixed room rent and keeping 100% of patient fees, or splitting a percentage of each fee with the clinic. Either way, if you're self-employed rather than an employee of the clinic, your qualifying income is the full patient fee, not the amount left after the clinic's cut. The clinic's percentage or room rent is then claimed back as a business expense.
Records for Patients, Insurers and Clinic Splits
Osteopaths and chiropractors typically earn from private patients and insurers, often at clinics where they pay rent or split fees. Records should capture each payer.
- Record patient fees on payment, with the session reference.
- Record insurer payments on receipt, matched to sessions.
- Record clinic rent or fee-split arrangements, and what you pay.
- Keep GOsC or GCC registration, indemnity and CPD costs.
- Keep couch, equipment and consumable receipts.
Where Osteopaths and Chiropractors Go Wrong on MTD
- Recording by treatment date. Insurer payments count when received.
- Recording the net after a clinic split. Record the gross fee and the split as a cost where that applies.
- Forgetting multiple clinics. They add together.
- Counting payroll pay. A salaried post is employment income.
- Expensing a couch in one go. Larger items are capital allowances.
A Sample Quarter: What the Update Looks Like
A sample quarter for an osteopath working two days at a clinic and one at home.
| Q2: 6 July to 5 October 2026 | Amount |
|---|---|
| Private patient fees | £10,400 |
| Insurer payments | £4,100 |
| Total income | £14,500 |
| Clinic rent and splits | £3,900 |
| Registration and indemnity | £620 |
| Equipment and consumables | £510 |
| CPD and software | £360 |
| Total expenses | £5,390 |
| Profit for the quarter | £9,110 |
The clinic’s share is a cost, and the gross fees are income.
Worked Example
Private (self-pay) patient fees, gross before clinic split: £22,400
Insurer-billed patient fees, gross before clinic split: £19,600
Total qualifying income: £42,000 — above the £30,000 Phase 2 threshold. Luz joins MTD from April 2027. Her 30% share paid to the clinic is claimed as a business expense against her profit, but her qualifying income for the MTD threshold is the full gross fee her patients (or their insurer) paid, not her 70% take-home share.
What You Can Claim
- Room rent or clinic percentage split paid to the clinic
- GOsC or GCC registration fees and professional body membership
- Professional indemnity insurance
- Treatment equipment — tables, TENS machines, ultrasound equipment
- CPD courses and training required to maintain registration
- Practice management software and patient record systems
- Consumables — couch roll, gloves, hygiene supplies
Best MTD Software for Osteopaths & Chiropractors
Software links are affiliate, help fund CheckMyMTD. Recommendations based on ease of use for self-employed income tracking.
Frequently Asked Questions
An insurer paid me three months after I treated the patient. Which quarter does it count in?
If you use the cash basis, which most self-employed practitioners do, it counts in the quarter you actually received the payment, not the quarter you treated the patient. This is worth tracking carefully given how variable insurer payment timing can be.
Is my qualifying income the full patient fee, or my share after the clinic's cut?
It's the full gross fee the patient (or their insurer) paid, before any room rent or percentage split is deducted. The clinic's share is then claimed back separately as a business expense, which reduces your taxable profit but not your gross qualifying income figure.
Do I combine private and insurer-billed income into one figure?
Yes, all your self-employment income from patient treatment combines into a single qualifying income figure for MTD, regardless of whether it was self-pay or processed through an insurer.
Can I claim my professional registration and indemnity insurance?
Yes, GOsC or GCC registration fees, professional body membership, and indemnity insurance are all normal allowable business expenses for a self-employed practitioner.
I work at two different clinics. Do I add both incomes together?
Yes, if you're self-employed at both, all your practice income combines into one qualifying income figure regardless of how many clinics or locations you work from.