Med Spa Payroll Taxes Explained: FICA, FUTA, State Unemployment and Commission Pay in 2026

A med spa payroll is unlike the payroll at the dentist next door. Half of an injector's pay is commission that arrives in a lump a month after the treatments, the esthetician's tips come through the POS at checkout, a December bonus goes out the week the practice sells its biggest packages of the year, and the medical director is paid outside payroll altogether. The payroll provider turns all of that into deposits and forms well enough that an owner can run it for years without knowing why the bank debit labeled "IRS USATAXPYMT" is the size it is.

That works until a commission check looks "taxed wrong," a Florida rate notice goes unread, or a slow February makes the payroll tax deposit look like the easiest bill to push. Here is what a med spa employer pays in 2026, when it is due, and why it is the one liability a practice never defers.

Three buckets on a med spa payroll register

Every payroll splits into three kinds of tax. The first is money withheld from the employee's own wages and forwarded to the government: federal income tax plus the employee's share of Social Security and Medicare. It was never the practice's money. The second is the employer's matching share of Social Security and Medicare, a real cost on top of gross wages. The third is unemployment tax, federal and state, which only the employer pays and which stops early in the year for a full-time provider.

The federal figures come from IRS Publication 15 and the Social Security Administration: 6.2% each side on the first $184,500 of 2026 wages, 1.45% each side with no limit, and an extra 0.9% withheld from the employee only once her wages pass $200,000. Commissions, retail commissions, bonuses and reported tips are all wages for these taxes; the only payroll-adjacent cost that escapes them is the medical director's fee, because it is not payroll at all, as our guide to paying a med spa medical director explains.

Commissions and bonuses: supplemental wage withholding

A commission is a supplemental wage, and Publication 15 gives payroll providers two ways to withhold federal income tax on it. If the commission is paid separately from regular wages or separately identified on the same check, and income tax was withheld from her regular wages in the current or preceding calendar year, the provider may withhold at a flat 22%, which is what most systems do by default when commission runs as its own pay type. Alternatively the commission can be aggregated with the regular wages for the period and withheld under the W-4 tables.

The 22% flat rate is why an injector tells you her commission check was "taxed more than her paycheck." It was not taxed more; it was withheld at a flat rate that may be above or below her actual bracket, and the difference settles on her Form 1040. Social Security and Medicare come out of the commission at the same 7.65% as any other wage, and the practice matches it.

Two timing points matter in a med spa. First, wages are taxed when paid, so December production commissions paid in the first January payroll are 2027 wages on a 2027 W-2, while your books accrue them in December; the commission accrual is what keeps provider cost next to the revenue that produced it. Second, for hourly staff the commission is part of the regular rate for overtime, and a monthly commission has to be apportioned back over the weeks it was earned in; the mechanics are in our first-hire payroll checklist.

Tips and service charges at checkout

Estheticians, massage therapists and sometimes injectors receive tips through the POS tip prompt at checkout. Tips are wages for payroll tax purposes: the IRS tip rules require employees to report cash tips to the employer unless they total less than $20 in a month, by the 10th of the following month, and the employer withholds income tax and the employee's share of Social Security and Medicare on wages plus reported tips, and pays its own 7.65% match on the tips. Make sure the POS tip report feeds the payroll run as a separate tip earning code rather than being paid out of the drawer.

A charge is a tip only if the patient decides voluntarily whether to pay it and how much. The IRS is specific that a mandatory gratuity, or a digital prompt that requires the patient to choose a tip above zero, is a service charge, and service charges distributed to staff "are generally treated as wages paid by the employer to the employee rather than tips." Set the POS tip screen to offer a no-tip option; otherwise the esthetician's "tips" are wages for every purpose, including overtime.

The 2025 law also created a deduction for qualified tips. It is the employee's deduction, not the employer's: up to $25,000 a year, phasing out above $150,000 of modified adjusted gross income ($300,000 joint), for tax years 2025 through 2028. The final regulations issued in April 2026 list the occupations that qualify, and the list includes skincare specialists and massage therapists but not nurses or other medical occupations. Two cautions. The statute excludes tips earned in a trade or business that is a specified service trade or business, which includes health, and whether a given med spa is one is unsettled; the IRS has said it will not apply that exclusion to listed occupations until the January 1 after it issues final rules on the point. And the deduction changes nothing on the employer side: the Federal Register notice states that the deduction "does not apply for FICA purposes," so you still withhold, match, deposit and report tips as before, with the tipped-occupation code the final rules add to the W-2.

Deposits, forms and the penalty for running late

The 941 taxes, meaning withheld income tax plus both halves of Social Security and Medicare, are deposited through EFTPS on a schedule set each year from a lookback period. Under IRS Topic 757, the lookback for a Form 941 filer is the four quarters from July 1 two years ago through June 30 of last year. If you reported $50,000 or less of these taxes in that window you are a monthly depositor and each month's taxes are due by the 15th of the following month; above $50,000 you are semiweekly, with taxes on Wednesday through Friday paydays due the following Wednesday and taxes on Saturday through Tuesday paydays due the following Friday. New employers start monthly.

Two overrides. If you accumulate $100,000 or more of liability on any day, that amount is due the next business day. If your liability for a quarter is under $2,500, you may pay it with the Form 941 instead of depositing. FUTA runs on its own track: deposit by the end of the month after any quarter in which cumulative FUTA liability exceeds $500, per Topic 759.

Late deposits are penalized on the whole deposit: 2% if 1 to 5 days late, 5% at 6 to 15 days, 10% beyond 15 days, and 15% if still unpaid 10 days after the first IRS notice, per the failure-to-deposit schedule. A $14,000 monthly deposit sent a week late costs $700. Behind the penalty sits the Trust Fund Recovery Penalty: the withheld income tax and employee FICA are trust fund money, and the IRS can assess the full unpaid balance personally against any responsible person, owner, manager or payroll service, who knew the tax was owed and paid something else first. The LLC does not shield it. In a cash crunch, talk to the landlord first; never fund the practice with payroll tax.

The state side: Florida and the states without withholding

Florida has no personal income tax, so there is no state withholding account and no state W-4. The same is true of the other states that impose no tax on wages: Alaska, Nevada, New Hampshire, South Dakota, Tennessee, Texas, Washington and Wyoming. A practice in a state with an income tax, from Arizona to New York, withholds state income tax under that state's own form and files its own reconciliation; the payroll provider handles the mechanics, but each state registration is yours to open before the first payroll there.

Every state has an unemployment tax, and Florida's is called reemployment tax. Per the Florida Department of Revenue, a new employer pays 2.7% on the first $7,000 of each employee's wages, a maximum of $189 per employee per year, until it has reported for 10 quarters; the state then assigns an experience rate between 0.1% ($7 per employee) and 5.4% ($378) for 2026 based on the benefits former staff have drawn against the account. Liability begins at $1,500 of wages in a quarter or an employee in 20 weeks, you register on Form DR-1, and the RT-6 is due with the 941 each quarter; employers with 10 or more employees in any quarter of the prior state fiscal year must file and pay online. The rate notice arrives in December. Enter it in the payroll system, or next year runs at the wrong rate.

Worked example: an Orlando injector earning $85,000 plus $30,000 of commission (illustrative)

Take an illustrative single-location practice in Orlando, Florida, in its second year, with three injectors, an esthetician and two coordinators, filing Form 941 as a monthly depositor. Its lead injector, a W-2 nurse practitioner, is paid an $85,000 salary biweekly ($3,269.23 a period) plus a service commission that totals $30,000 for 2026, paid monthly as a separately identified pay type. Her gross wages are $115,000, below the Social Security wage base and below the $200,000 Additional Medicare threshold.

The practice's own tax on this injector is $9,029, or 7.85% of her wages: 7.65% of FICA match plus $231 of unemployment taxes that were fully paid by the end of her second salary check in January. Her commission carried $6,600 of federal withholding at the flat rate plus $2,295 of her own Social Security and Medicare, so a $2,500 monthly commission arrived as roughly $1,759 in her account. If her December commission is paid January 8, 2027, it belongs on her 2027 W-2 and in the practice's January 2027 deposit, even though the books accrued it in December.

Each biweekly 941 deposit covers the federal income tax withheld from all six employees plus both halves of FICA, due by the 15th of the following month; the $189 of Florida tax goes with the quarterly RT-6, and FUTA for the six-person staff, $252, is paid once it passes $500 or with the Form 940 in January.

What usually goes wrong

Three failures account for most of the payroll notices we see in med spa files. A commission or final paycheck cut outside the payroll system, by check or Zelle, so nothing is withheld or deposited and the W-2 is wrong. A Florida rate notice that arrives in December and is never entered. And an owner in a thin quarter who pays the filler vendor first and the IRS second, the trust fund problem in slow motion.

Less dramatic but common: tips paid out of the drawer and never run through payroll; a POS tip prompt with no zero option, which turns tips into service charges and wages; the esthetician's commission paid quarterly with no overtime true-up; an S corporation owner-injector's health insurance left off her W-2; December commissions deducted on the 2026 return although they were paid in January; and a payroll provider trusted so completely that nobody logs into EFTPS to confirm the deposits posted.

When to get help

Payroll tax is not hard to understand; it is unforgiving of small errors repeated 26 times a year. The moments to get help are before the first hire, when the pay types, the Florida registration and the deposit schedule are set up once; when the second injector's commissions push the practice from monthly to semiweekly deposits; and the day any IRS or state payroll notice arrives, because those balances are cheapest to fix early. If a provider is being paid outside payroll today, start with our guide to employee versus independent contractor rules for med spas before the next check goes out.

Our med spa payroll and provider compensation service sets up and runs payroll in Gusto, ADP, Paychex or QuickBooks Payroll with separate codes for base, commission, retail commission and tips, ties each month's commissions to the production report, monitors deposits against EFTPS, reconciles the four 941s to the W-2s every January, and handles the Florida and multi-state side including rate notices. For a review of how your payroll taxes are being handled today, request a 20-minute fit call and bring one payroll register and your last Form 941.

Jenny Gao, CPA, EA

Founder of Balance Partners, a CPA-led accounting, tax and fractional CFO practice for med spas. Florida-licensed CPA and IRS Enrolled Agent with more than 13 years of accounting and tax experience. Jenny writes and reviews every guide on this site. About Jenny

This guide is general educational information for owners of med spas and aesthetics practices in the United States and is not accounting, tax, legal, medical, payroll or financial advice for your situation. Rules change and vary by entity, state and facts. Balance Partners, LLC does not provide audit, review, compilation or other attest services. Last reviewed November 8, 2026.