Quarterly Estimated Taxes for Med Spa Owners: How to Calculate and Pay in 2026

A med spa deposits money every day. The POS settles, the card processor pays out, the bank balance looks healthy, and nothing in that flow stops to set aside income tax. Whether the practice is an LLC, a partnership or an S corporation, the profit reaches your personal return with no tax withheld, and the IRS expects to be paid as the year goes, in four installments. Miss them and next spring's return carries a penalty that is really interest, figured installment by installment, whether or not anyone told you the rule existed.

The system is more forgiving than it looks. There are safe harbors that let you pay a known number instead of guessing, a method built for businesses whose profit arrives unevenly, which describes most med spas, and, for S-corp owners, a December fix that works better than any estimated payment.

Who pays, the 2026 calendar and the safe harbors

You must make estimated payments if you expect to owe at least $1,000 for 2026 after subtracting withholding and refundable credits, and your withholding will not reach the safe-harbor amounts below. That covers nearly every profitable med spa owner: the sole-member LLC owner whose practice lands on Schedule C, partners in a two-owner practice, and S-corp shareholders whose K-1 carries the profit left after their own salary. The S corporation itself pays no federal income tax, so the estimates are yours personally, paid under your Social Security number, not the practice's EIN.

The four periods are not equal quarters, and every 2026 date falls on a weekday, so none shift. The IRS Form 1040-ES for 2026 gives the schedule:

The second period is only two months long, which is why owners who set a reminder "every three months" are late every June. When a due date does fall on a weekend or legal holiday, the next business day counts, and you may pay more often than quarterly; the IRS only cares that the cumulative amount is in by each date.

You avoid the penalty entirely if, by each due date, your payments plus withholding reach the smaller of two targets: 90% of the tax you will actually owe for 2026, or 100% of the total tax on your 2025 return. If your 2025 adjusted gross income was more than $150,000 ($75,000 if you file separately), the prior-year target becomes 110%. Most owners of a practice doing $1 million or more cross that line. And if you owe less than $1,000 after withholding when you file, there is no penalty at all.

The prior-year safe harbor is the one we lean on in a growth year, because it turns a forecast into a fixed number: last year's total tax, times 110%, minus expected withholding, divided by four. The cost is that a practice that just added a second injector or a membership program will owe a large balance in April 2027. There is no penalty on that balance, but it is a real cash call, and gift-card season is not the time to discover it. The current-year method is better when profit is falling, say in a second-location opening year, because paying 110% of a strong prior year means lending the IRS money. Either way, the safe harbor is measured at each due date: paying nothing until January and then sending the whole annual figure does not cure the first three installments.

Computing the payment from a med spa's books

Under the current-year method the source document is the profit and loss statement, and in a med spa the P&L has to be adjusted before it says anything about taxable income. The steps we run each quarter:

1. Start from the closed books, not the POS dashboard. Year-to-date net income from a reconciled P&L, projected to a full year with what you know is coming: a new provider, a price change, a planned device purchase.
2. Convert to the tax basis. If your books are accrual (they should be, because of packages) but your return is cash-method, packages, memberships and gift cards sold but not yet performed are taxable when the money was received; the deferred revenue liability on the balance sheet is income for this purpose. Injectables go the other way: product in the refrigerator on December 31 is inventory, not a deduction, under either method.
3. Add the owner-level items the books do not show. Owner health insurance, retirement contributions, Section 179 or bonus depreciation on a laser placed in service this year, and personal spending that landed in the business accounts.
4. Compute self-employment tax if you are not an S corporation. It is 15.3% of 92.35% of net earnings, with the 12.4% Social Security portion stopping at $184,500 of earnings for 2026; half of it is a deduction.
5. Finish the household return. Add a spouse's wages and other income, subtract the 2026 standard deduction ($32,200 joint, $16,100 single) or itemized deductions, subtract the qualified business income deduction if your taxable income allows it, and apply the 2026 brackets.
6. Compare to the safe harbor. Add income tax and self-employment tax, subtract withholding, take 90% of the result or the prior-year figure if lower, divide by four, and true it up each quarter.

Steps two and three are where a generic worksheet fails a med spa. A $90,000 laser installed in October can erase the September and January installments; $35,000 of neurotoxin ordered in December to reach a manufacturer rebate tier does not reduce them at all. Our guide to reading a med spa P&L shows where each item sits in the books.

Worked example: an owner-injector in Tampa (illustrative)

An illustration with round numbers, not a client. A nurse practitioner owns a single-location practice in Tampa, Florida, taxed as an S corporation, with two other injectors and an aesthetician on payroll and about $1.4 million of annual revenue. She pays herself a $120,000 salary with $14,000 of federal withholding. Through August the books project $210,000 of ordinary income on her K-1 for 2026. Her spouse earns $80,000 in wages with $8,000 withheld. They file jointly with the standard deduction. Their 2025 return showed $48,000 of total tax on $300,000 of adjusted gross income, so the 110% rule applies.

She can pay $7,700 a quarter, owe no penalty, and write a check for about $13,000 in April 2027. Or she can pay $9,300 and arrive in April nearly square. Her 2026 AGI of about $410,000 also sets her 2027 safe harbor at 110% of the 2026 tax, roughly $72,400 before withholding. Florida has no personal income tax, so she has no state estimate; an owner in most other states would add one.

Notice the QBI line. At $377,800 of taxable income she is under the 2026 joint threshold, so she gets the full 20% whether or not the practice is treated as a "health" specified service business. A strong fourth quarter could push her past $403,500, where that question starts to cost real money; we cover it in the QBI deduction for med spas.

Seasonal income: the gift-card surge and the summer lull

Most med spas do not earn evenly. January and February are strong, summer softens as patients travel and skip maintenance, and November and December bring the package promotions and gift-card sales that can make the fourth quarter the largest of the year. On a cash-method return, every gift card sold in December is 2026 income the day it is sold, redeemed or not. Four equal installments built on that calendar overpay in spring and summer, exactly when payroll is fixed and bookings are soft.

The annualized income installment method on Schedule AI of Form 2210 fixes this. Each installment is computed from the income actually earned through the end of its period: income through March 31 is multiplied by 4, through May 31 by 2.4, through August 31 by 1.5, and the full year by 1. The required cumulative payments are 22.5%, 45%, 67.5% and 90% of the tax on each annualized figure. A practice with a slow summer pays a smaller September installment, and the December surge is paid for on January 15, when the cash from it is actually in the bank.

Two conditions. You need books closed at each of the four cutoffs, which a monthly close gives you and a quarterly catch-up does not. And once you use Schedule AI for one installment you must use it for all four. A practice with steady membership revenue and no promotional calendar is better off with equal installments.

S-corp owners: use withholding instead

If your practice is an S corporation, you have a tool a Schedule C owner does not. Federal income tax withheld from wages is treated as paid in four equal parts on the four due dates, no matter when in the year it was actually withheld, unless you show otherwise. An owner-injector who realizes in November that K-1 income will run $60,000 ahead of plan can have the company withhold an extra $12,000 of federal income tax from December payroll, and the IRS treats a quarter of it as paid in April, June and September. The underpayment for those installments disappears retroactively; a late estimated payment only stops interest from the day it is made.

For most of our S-corp clients we skip separate estimates and set the owner's withholding to cover the K-1 income as well, then true it up in the December payroll run alongside the reasonable-salary review. A spouse's new Form W-4 can do the same for the last paychecks of the year. For the broader salary-versus-distribution question, see how a med spa owner should pay themselves.

State estimates, the penalty, and how to pay

Florida and Texas have no personal income tax, so a practice owner there has no state estimate on pass-through profit. Most other states do, usually on the federal dates with a similar safe harbor, but not always. California weights its installments 30% on April 15, 40% on June 15, nothing on September 15 and 30% on January 15, applies the 110% test at $150,000 of prior-year California AGI, and requires taxpayers with current-year California AGI of $1 million or more to pay 90% of the current year, according to the Franchise Tax Board. If your practice has elected a state pass-through entity tax, that election usually carries its own estimated payment schedule at the entity level, and your personal state estimate shrinks accordingly.

The federal penalty is figured on Form 2210 as interest on each installment's shortfall from its due date until it is paid or April 15, at the IRS underpayment rate, which is 7% per year for the quarter beginning October 1, 2026; the IRS resets it each quarter. At 7%, underpaying one $7,700 installment by three months costs about $135; paying all four $7,700 installments in April 2027 instead of on schedule costs about $1,400. It buys nothing, and it stacks with failure-to-pay penalties if the April balance also goes unpaid. Waivers are limited to casualty, disaster or other unusual circumstances, or retirement after age 62 or disability with reasonable cause. "My bookkeeper never mentioned it" is not on the list.

Paying is the easy part. IRS Direct Pay is free, needs no account, and lets you choose "estimated tax" and the 2026 tax year. Save every confirmation; a payment applied to the wrong year or to the practice's EIN is the most common reason an owner gets a notice.

What usually goes wrong

The same handful of mistakes account for nearly every penalty we clean up. Owners treat June's installment as due in July. They compute the payment once in April from last year's return and never revisit it as the practice adds a provider, then learn the 110% rule applied because 2025 AGI crossed $150,000. They project from the POS sales report instead of closed books. They expense a December neurotoxin stock-up and underpay January, or forget a laser installed in October and overpay it. In the first S-corp year they keep paying estimates on the whole profit while also having tax withheld from the new salary. And practices with an MSO and a professional entity get two K-1s and project from one.

Underneath most of these is a bookkeeping problem. If the P&L is three months behind, or the deferred revenue and inventory accounts are not reconciled to the POS, nobody can project the year. The projection belongs inside the monthly close, not in a separate conversation in March.

When to get help

If your profit moves materially from year to year, if a spouse has W-2 income, if you have elected S-corp status and are juggling salary withholding and K-1 income, or if you run a promotional calendar that stacks revenue into the fourth quarter, a quarterly projection built from closed books is worth far more than it costs. In our med spa tax planning and preparation work we run the projection off each month's close, convert it to the tax basis, tell you the amount and the date, and adjust S-corp withholding when that is the cleaner fix, as part of the Med Spa Core engagement rather than as a separate project.

If you have already missed installments this year, pay now to stop the interest, then decide whether the prior-year safe harbor or the annualized method reduces what is owed. Request a 20-minute fit call with your year-to-date P&L and last year's return, and we will tell you what the January 15 payment should be and whether a December payroll adjustment can replace it.

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.