Sales Tax Nexus for Med Spas: Online Retail, Second Locations and Where You Must Register

"Do we need to register in Georgia?" is the question that arrives after a med spa hires a remote patient coordinator in Atlanta, or after the web store's order report shows a cluster of ship-to addresses in one state, or when an injector is invited to do an event at a boutique across the state line. The answer starts with nexus: the connection between your practice and a state that lets the state require you to register, collect and remit its sales tax.

Nexus is the first question, not the only one. Whether you have nexus in a state and whether what you sell there is taxable are separate tests, and for a med spa the second one is unusual: treatments are not taxable in most states, so nexus matters almost entirely because of the retail product you sell and ship. This guide walks through physical and economic nexus as they apply to a practice, the situations that trip them, the order in which to register, what to do if you are late, and a decision table to work from.

Nexus and taxability are two different questions

A state can tax a sale only if it has a connection to the seller (nexus) and the item is taxable under its law. In your home state both are settled. A Florida practice has a location, employees and inventory in Florida, so it is a Florida dealer and registers on Form DR-1, with each business location registered; and Florida taxes retail product, including sunscreen and "medical grade" skincare unless dispensed under a prescription, while leaving cosmetic and medical services untaxed. Our guide to taxable services and products covers the taxability half.

Outside your home state, nexus has to exist before taxability matters. Texas does not list medical or cosmetic procedures among its taxable services, so a practice with Texas nexus collects nothing on treatments and the full rate on retail serums, and nothing on sunscreen with a Drug Facts panel, which Texas exempts. California generally does not tax spa services but taxes retail product and over-the-counter medicines unless prescribed. The pattern holds across most states: nexus is created by presence or sales, and once created it reaches the product, not the procedure. Hawaii, New Mexico, South Dakota and West Virginia tax services by default and need their own analysis.

Physical nexus: locations, people, inventory and events

Physical presence is the oldest form of nexus and still creates it everywhere, with no sales threshold. For a med spa it comes from more places than the building.

• A location. A second treatment site in another state is nexus from the day you start operating there, before the first patient is seen and before the first serum is sold.
• People. An employee working from home in another state, whether a patient coordinator, a marketing manager or an injector who lives across the state line, creates presence in that state. Contractors performing work for you there can as well.
• Inventory. Retail stock held in a third-party fulfillment warehouse for your web store is your property in that state. Florida treats inventory in a Florida fulfillment center as physical presence regardless of sales volume, and most states take the same view.
• Events. An injector doing a one-day event at a partner clinic in another state, an aesthetician selling skincare at a wellness fair in Nashville, a booth at a conference where product is sold: each is in-state activity, and product sold at the event is a sale sourced to that state. Several states issue temporary permits for exactly this; California's temporary seller's permit covers selling at one location for up to 90 days.

One caution on events that is not a tax point. A provider's license to inject is state-specific, and whether a nurse practitioner or registered nurse licensed in Florida may perform treatments at an event in another state is a question for that state's board and a health-care attorney licensed there, before any sales tax question. The tax review follows the legal one, not the other way around.

Economic nexus after Wayfair

Since South Dakota v. Wayfair (2018), a state can also require registration based on sales into it alone. Most states set the threshold at $100,000 of sales, and many have dropped the old 200-transaction test; California, Texas and New York use $500,000, with New York also requiring more than 100 sales. Each state measures over its own period and decides whether marketplace sales count, so a nexus review runs state by state.

A med spa's online skincare line rarely approaches $500,000 into any one state. The reachable tests are Georgia's 200 separate retail sales in the current or prior calendar year, which 200 orders of a $60 cleanser satisfy, and the $100,000 tests in states where a practice has a following. Texas's $500,000 counts total Texas revenue, taxable and nontaxable, goods and services, over the preceding twelve months and includes marketplace sales; Florida's $100,000 test, which matters to an out-of-state practice shipping into Florida, excludes them. The state-by-state table and the marketplace rules are in selling skincare online.

A decision table for the situations that actually come up

Registration sequencing, and what to do if you are already late

Home state first, always, for every location. Then states where you have physical presence: a location, an employee, inventory, a recurring event. Those obligations have no threshold and usually the longest exposure, because they began the day the presence did. Then economic nexus states, ranked by dollars at risk. Each registration creates a filing duty, including zero returns, and a Florida zero return filed late still carries the $50 minimum penalty; other states have their own. Do not register where you have no nexus "to be safe."

Timing rules differ. Texas gives a remote seller until the first day of the fourth month after the month it crosses $500,000, and lets it collect a single local use tax rate of 1.75% on top of the 6.25% state rate instead of tracking every local jurisdiction. Georgia counts the current year, so the obligation can begin mid-year. For a one-off event, ask the state for its temporary permit rather than opening a permanent account you will have to close. And a sales tax registration in a new state is rarely alone: an employee there means payroll tax registration, covered in med spa payroll taxes explained, and a location or significant sales there can mean income or franchise tax filings, which your CPA should sequence with the sales tax work.

If you are already late, the sequence gains one step at the front. Finding out you crossed a threshold or had an employee in a state two years ago is common, and the wrong response is to file the old returns at random. The right one is to measure first: taxable sales into the state since nexus began, times the average combined rate, plus interest. For a med spa the number is usually modest, because only retail is taxable, which is exactly why it is worth resolving cleanly.

Most states run a voluntary disclosure program. Florida's looks back three years from the postmark of your request and waives penalties once tax and interest are paid, except where tax was collected and not remitted, which draws a 5% penalty; you must not have been contacted by the Department first. Other states' programs follow a similar shape, typically a three- or four-year lookback with penalty relief and interest in full, and they generally require you to come forward before registering. A practice that quietly registers today for exposure that began in 2024 has told the state it exists and given up its bargaining position. Measure, disclose, register, then collect, in that order.

Worked example: an Orlando practice with a Georgia hire, a web store and an Atlanta event (illustrative)

Take an illustrative practice in Orlando (Orange County, 6.5% combined rate) with three injectors and about $2.2 million of annual revenue, owned by one LLC. During 2026 four things happen.

The coordinator hire is the item owners miss. Nothing about sales changed in March, but an employee in Georgia is physical presence, and because the practice registered in March, the $22,000 of Georgia web orders and the $4,000 sold at the event were taxed at checkout at destination rates, roughly $1,800 at an assumed blended 7% that patients paid rather than the practice. Had the practice waited for the 200th order in August, the roughly $9,000 shipped to Georgia between March and August would have gone uncollected, about $630 of tax funded from margin plus interest: small enough to fix with a voluntary disclosure, large enough to appear as a finding when the practice is sold. Texas stays off the list. At home, the Orlando location collects 6.5% at the front desk and the delivery county's rate on shipped orders, 7.5% to a Tampa address, as it always has.

What usually goes wrong

Registering in every state the web store ships to, then drowning in zero returns. Measuring nexus by the patient's billing address instead of the ship-to address. Forgetting the remote employee because payroll is "handled by Gusto" and nobody connected it to sales tax. Not knowing which state the fulfillment company keeps the retail stock in. Counting marketplace sales toward thresholds in states that exclude them, or excluding them in states that include them. Filing old returns for a missed state without a voluntary disclosure, and losing the penalty waiver. Treating a brand storefront's shipments as your sales. Sending an injector to an out-of-state event without checking licensing, then discovering the sales tax question was the easy one. And at home, assuming a second Florida location is covered by the first certificate; the registrations and rates by site are in our multi-location guide.

When to get help

If your practice has a remote employee, a fulfillment warehouse, an out-of-state event on the calendar, or a web store whose order report shows one state climbing toward 200 orders, run the nexus review now rather than after a notice. The review takes a sales-by-ship-to-state export, a payroll register with employee addresses and a list of where inventory sits, and it answers the question for every state in one pass.

Balance Partners handles med spa sales tax compliance as part of monthly accounting, including the nexus review, voluntary disclosures where a practice is late, and registrations sequenced with the payroll side of a remote hire. Request a 20-minute fit call and bring the three exports above; we will tell you where you stand, state by state.

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.