Sales tax in Washington for med spas
The Department of Revenue’s Beauty and Wellness Services guide has a medical spa page, and it is direct: income from medical spa services — it names Botox and dermal fillers, PRP, microneedling, ultrasonic body sculpting, laser treatments and chemical peels — is taxed under the Service and Other Activities B&O classification and you do not collect sales tax. Facials and dermaplaning sit in the same classification. Tanning is the exception: it is a retail service, and a non-itemized package that bundles a taxable service is taxed in full, so itemize.
Retail is different. Skincare, sunscreen and devices sold to patients are Retailing B&O plus retail sales tax at the rate where the patient takes the product. The state rate is 6.5%; combined rates for October 1 through December 31, 2026 are 10.55% in Seattle, 10.50% in Tacoma, 10.30% in Bellevue, 9.10% in Spokane and 8.90% in Vancouver. The practice is the consumer of gloves, numbing cream and equipment and pays sales or use tax when it buys them; products for resale go on a reseller permit.
In Seattle: a $600 neuromodulator treatment, a $120 serum and a $45 sunscreen on one ticket. Only the $165 of retail is taxed: $165 × 10.55% = $17.41, ticket total $782.41. The $600 also owes $9.00 of Service B&O at 1.5% on the same excise tax account. Our med spa sales tax guide covers packages and gift cards.
Who can own a med spa in Washington (CPOM and supervision, summarized)
This is a summary, not legal advice. The Department of Health publishes a guidance page for anyone opening a med spa, and it gives no flat ownership rule: whether the law permits you to hold an ownership interest is a question for an attorney, and it names the corporate practice of medicine, fee-splitting and aiding unlicensed practice as the issues. One carve-out is in statute — a physician assistant may own a health-care clinic (RCW 18.71A.120(8)) — and the Medical Commission says PA ownership changes none of the practice rules. Other non-physician owners typically land on an MSO supporting a physician-owned PLLC.
Clinical lines are clearer. Under WAC 246-919-606, injecting a substance or using a prescription device for cosmetic purposes is the practice of medicine. The physician examines, diagnoses and obtains consent before authorizing treatment, then may delegate to a PA, RN or LPN under a written office protocol. For FDA-approved uses the physician need not be on site but must be reachable by phone and able to respond within thirty minutes; off-label substances require the physician on site; a physician may sponsor no more than three PAs. Lasers fall under WAC 246-919-605; an esthetician may use one only under MD or DO supervision.
The Board of Nursing’s advisory opinion (September 12, 2025) lets RNs and LPNs administer legend drugs and biologics under an authorized practitioner’s direction; neither may diagnose or prescribe. The Commission’s medical director guideline (reaffirmed October 11, 2024) warns licensees to be wary of arrangements with unlicensed persons. Confirm all of it with a health-care attorney licensed in Washington.
State business taxes for a Washington med spa entity
Washington has no corporate income tax and, today, no personal income tax. What it has is the B&O tax on gross receipts, with no deduction for costs, whatever the entity type. Since October 1, 2025 (ESHB 2081) the Service and Other Activities rate depends on the prior year’s taxable income: 1.5% under $1 million, 1.75% from $1 million to $4,999,999.99, and 2.1% at $5 million or more. Retail sales are taxed at 0.471%, rising to 0.5% on January 1, 2027.
Cities add their own. Seattle’s 2026 rules exempt businesses with under $2 million of taxable Seattle revenue (you still file a $0 return); above that a $2 million standard deduction applies and the rates are 0.658% on services and 0.342% on retail. Other cities have their own B&O taxes; we check each location.
Two taxes reach owners rather than the practice. The capital gains tax is 7% on the first $1,000,000 of taxable long-term gains and 9.9% above that, effective tax year 2025, which matters the year you sell. And SB 6346, signed March 30, 2026, imposes a 9.9% tax on Washington taxable income above $1 million per household — pass-through profit and gains included — starting January 1, 2028. Voters kept it on November 3, 2026 by rejecting Initiative 645, and a constitutional challenge is set for hearing on February 5, 2027. If a sale is in your plans, see our guide to selling a med spa.
Payroll in Washington for injectors and front desk
There is no state income tax withholding, so a Washington pay stub skips that line and adds three others. Unemployment insurance runs through the Employment Security Department on a 2026 taxable wage base of $78,200 per employee ($82,000 in 2027). A new employer pays 115% of the average rate for its industry, never below the 1% federal floor, and reports are quarterly.
Paid Family and Medical Leave is 1.13% of wages for 2026, up to the Social Security wage cap, split 28.57% employer and 71.43% employee. Employers with fewer than 50 employees do not owe the employer share unless they choose to but must withhold and remit the employee share, so a single-location practice deducts about 0.807% from each paycheck. WA Cares is a 0.58% employee-paid premium on all wages with no cap, reported on the same quarterly filing; an employee with an approved exemption letter is not deducted. Workers’ compensation is written through the Department of Labor & Industries rather than a private carrier.
The state minimum wage is $17.13 for 2026, and an employee must earn at least 2.25 times the minimum wage — $1,541.70 a week, $80,168.40 a year — to be overtime-exempt, which catches many salaried practice managers. Injectors are W-2 under the IRS common-law test: the practice sets the schedule, the protocols and the price list. See how we structure injector pay.
Registrations, filings and deadlines checklist for a Washington med spa
What a Washington med spa registers for, in order; fees checked November 2026; licensing rows summarize, not advise.
| Item | Where | Fee / due date | Source |
|---|---|---|---|
| Form the entities (owner’s LLC; physician PLLC if used) | Washington Secretary of State | $180 certificate of formation | SOS fee schedule |
| Annual report, each entity | Secretary of State | $70; $95 if delinquent | SOS |
| State business license and UBI (opens the B&O and sales tax account) | Department of Revenue Business Licensing Service | $50 to open; $5 at renewal | DOR |
| Combined excise tax return | My DOR | Monthly, quarterly or annual as assigned | DOR |
| Unemployment account; Paid Leave and WA Cares reporting | Employment Security Department | Quarterly; 2026 wage base $78,200; premiums 1.13% and 0.58% | ESD |
| Workers’ compensation | Department of Labor & Industries | State fund; quarterly | L&I |
| City business license and B&O | City (Seattle shown) | $73 to $3,210 a year by revenue; B&O return even at $0 under $2 million | Seattle |
| Personal property listing (equipment) | County assessor | Annual | DOR guide |
| Clinical filings | Medical Commission; Board of Nursing; Department of Licensing | Written office protocols (WAC 246-919-606); DOL salon license if estheticians work on site | WMC, DOH |
Federal items are in our opening checklist.
How we work with Washington med spas from Tampa
Onboarding is remote: a 20-minute fit call, then read-only access to your bank, processor and POS. We pull exports from Boulevard, Zenoti, Aesthetic Record, Vagaro, Mindbody, Nextech, PatientNow or Jane into QuickBooks Online, split revenue between Service B&O, Retailing and tanning, and close the books by the tenth business day. Tampa is three hours ahead of Seattle, so your numbers are waiting when you open and we take calls in your morning.
We file the combined excise tax return, the ESD quarterly reports with Paid Leave and WA Cares, the city B&O return, and the federal returns for every entity. You keep your Washington health-care attorney, Medical Commission protocols, the L&I account, and signing what we prepare. Med Spa Core starts at $1,500 a month, month-to-month after onboarding with thirty days’ written notice; see pricing, the med spa service page or request a fit call.
A Washington example
Illustrative only: a single-location Bellevue practice, a physician-owned PLLC taxed as an S corporation, with $1,400,000 of revenue in both years, six employees, $160,000 of retail and $300,000 of profit.
- Sales tax. Retail of $160,000 is taxable at Bellevue’s 10.30%: $16,480 collected for the year. Tax on $1,240,000 of treatments: $0.
- B&O tax. Prior-year taxable income is over $1 million, so treatments are taxed at 1.75%: $1,240,000 × 1.75% = $21,700. Retail at 0.471%: $753.60. State B&O for the year: $22,453.60. Bellevue’s city tax is separate.
- Income tax. On $300,000 of profit: $0. The 9.9% tax arriving in 2028 would not reach this owner unless a sale pushed household income past $1 million.
- Payroll. The first injector, paid $85,000: unemployment tax on the $78,200 wage base at an illustrative 1.0% new-employer rate, $782, plus $42 of federal FUTA. Paid Leave premium $960.50, of which the employee’s 71.43% share is $686.09 and the employer share is $0 at under 50 employees. WA Cares withheld from the employee: $493.