What Monthly Bookkeeping for a Med Spa Should Include (And What Generalists Skip)

"Monthly bookkeeping" means different things to different providers, and in a med spa the difference is the whole value of the service. One version categorizes the bank feed, reconciles the checking account and emails a P&L on the 25th. The other starts from the POS, carries the package liability, counts the injectables, ties commissions to payroll and files the retail sales tax, and lands on your desk by the tenth business day with the numbers explained. Both are sold as bookkeeping. Only one tells you whether last month made money.

This guide lists what a monthly engagement for an aesthetics practice should deliver, explains the entries generalists skip and why, lays out a sample monthly calendar with the compliance dates on it, walks through one month's report pack at an illustrative Tampa practice, and gives you the questions that separate a bookkeeper who has closed med spa books from one who has read about it.

The monthly deliverable list

Here is what we deliver every month under med spa bookkeeping and monthly close, what each item is checked against, and why a generalist usually leaves it out. If a proposal does not name these, assume they are not included.

What "closed by the tenth business day" has to mean

"The books are up to date" and "the books are closed" are different claims. Up to date means the bank feed is categorized through last week. Closed means that for a finished month every bank, credit card, merchant and loan account has been reconciled to an outside statement, the adjusting entries are posted, the balance sheet has been reviewed line by line, the report pack has been issued, and the period is locked in QuickBooks Online so nobody changes October in January. In a med spa the balance sheet review is where the work is: the deferred revenue balance has to equal the POS, the inventory balance has to equal the count, sales tax payable has to equal tax collected less tax remitted, and Undeposited Funds has to be zero or explained.

The tenth business day is achievable when the POS exports, processor statements, count sheet and production report are pulled on the first business day, and it matters because the sales tax return is due by the 20th, the commission run is in the middle of the month, and a P&L delivered six weeks after month-end is history rather than management information. Our 12-step med spa close checklist walks through the sequence step by step.

The entries generalists skip

Deferred revenue, rolled forward to the POS

Money collected for a package, membership credit or gift card is a liability until the treatment is delivered or the balance is forfeited under terms the patient signed. Each month: opening balance, plus sales, less redemptions, less expirations per policy, equals closing balance, and the closing balance ties to the POS outstanding-balance report. Redemptions are the month's revenue from those programs; the sales are not. Florida gift certificates may not expire under section 501.95, so gift card balances stay until used. Without this entry, the P&L follows your promotion calendar instead of your treatment room. The packages, memberships and gift cards guide covers the policy side.

Inventory and cost of goods sold

Neurotoxin, filler and retail skincare are counted on the last business day of the month, by unit or syringe and by piece, and valued at cost. Cost of goods sold is opening inventory plus purchases less closing inventory, and units relieved are compared with units billed in the POS treatment log; the gap is waste, samples, staff treatments or shrink, and it should be small and explained. This is the only way injectable gross margin means anything, because practices buy product in bulk to hit supplier tiers and dispense it over months. Our injectables and retail inventory guide covers valuation.

Commission tie-outs to payroll

Injectors are usually paid base plus a percentage of the services they delivered, calculated from the production report on recognized revenue, net of discounts, excluding tax, tips and gift card sales, with package treatments counted when delivered rather than sold. The accountant computes the commission, accrues it in the month earned, sends the figure to payroll, and reverses the accrual when the register shows it paid, so provider cost lands in the same month as the revenue it produced and the payroll register ties to the plan. The injector compensation guide covers plan design.

Sales tax by state

Treatments are not taxed in most states; retail skincare and devices are taxable in essentially every state with a sales tax. Each month, taxable sales per the POS tax report times the rate should equal tax collected, sales tax payable should equal tax collected less tax remitted, and the return is filed from the reconciled liability, not from the POS alone. In Florida the rate is 6% plus the county surtax (1.5% in Hillsborough, 1% in Pinellas and Pasco for 2026), returns are due on the 1st and late after the 20th of the following month, and an electronic filer who pays on time keeps a collection allowance of 2.5% of the first $1,200 of tax, at most $30, per the DR-15 instructions. Use tax on supplies bought tax-free is added, because under Florida Rule 12A-1.020 the practitioner is the consumer of items used in treatments. A practice shipping skincare to other states tracks economic nexus thresholds, most of which sit at $100,000 of sales.

A sample monthly calendar

This is the rhythm for a calendar-year practice with one Florida location, employees paid twice a month, and a monthly federal payroll deposit schedule. Dates shift to the next business day when they fall on a weekend or holiday, and a semiweekly depositor replaces the 15th with Wednesday and Friday deposits.

Worked example: October's report pack at a Tampa practice (illustrative)

Consider an illustrative single-location practice in Tampa with about $1.5 million of annual revenue, owned by a nurse practitioner who injects, with two employed injectors, one aesthetician, a membership program and a retail skincare wall, running Boulevard, QuickBooks Online and Gusto. October's pack, issued on the tenth business day of November, reads like this.

The POS sales-by-category report shows $114,000 of recognized revenue: $72,000 injectables, $21,000 energy devices, $9,000 skincare treatments and $12,000 retail, with each line tied to its income account to the dollar. Card sales of $108,000 settled as $104,760 of deposits after $3,240 of processing fees, with $4,100 from October 30 and 31 in transit and recorded as a receivable; the fees sit in their own expense line rather than vanishing into net revenue. Tips of $2,900 went to a liability and out through payroll.

The deferred revenue rollforward opens at $96,000, adds $18,500 of package and membership sales, releases $16,200 of redemptions into the service lines above, and recognizes $600 of forfeited membership credits under the signed terms, closing at $97,700, which equals the POS outstanding-balance report. Inventory opened at $38,000, purchases were $27,000 and the October 31 count valued stock at $36,500, so cost of goods sold is $28,500; the injectable portion, $24,000, is 33% of injectable revenue, up two points from the trailing three months, and the open-items list asks about a filler promotion and 14 unexplained units. Commissions computed from the production report total $26,000, accrued in October and matched to the November 5 Gusto register. Taxable retail of $12,000 at Tampa's 7.5% produced $900 of tax collected per the POS tax report, which equals the liability account, and the DR-15 is filed by November 20 with a $22.50 collection allowance. The owner's one-page KPI sheet shows cash of $141,000 against the $97,700 owed to patients, so about $43,000 of the bank balance is hers before taxes and the laser payment.

What to ask a bookkeeper who says they "do med spas"

Every bookkeeper with a salon or dental client will say they understand the industry. Ask these, and listen for the specialist's answer.

• How do you record a package sale? As a liability, released as treatments are delivered, with a monthly rollforward tied to the POS. If the answer is "as revenue, it is cash basis," keep interviewing.
• How do you post merchant deposits? Gross sales from the POS, fees as expense, in-transit receivable for month-end. Not the net deposit.
• Who counts inventory and how do you book cost of goods sold? The practice counts on the last business day; the bookkeeper values the count and books COGS from it, and compares units relieved with units billed.
• How is commission calculated, and when is it recorded? From the production report under the written plan, excluding package sales until delivered, accrued in the month earned and tied to the payroll register.
• Which of my retail items are taxable in my state, and who files the return? A specific answer naming the state's rate, the POS tax report and the filing date.
• Which POS and EMR systems have you reconciled to QuickBooks Online? Aesthetic Record, Boulevard, Zenoti, Vagaro, Mindbody, Nextech, PatientNow or Jane, with an explanation of what the integration does and does not post.
• What is in the monthly pack, and when does it arrive? A named close date, a P&L by service line, a reviewed balance sheet, the rollforward, KPIs and an open-items list.
• Who reviews your work? A CPA who reads the balance sheet every month, not just the preparer in March.

Our guide to choosing a med spa accountant covers the rest of the interview, including red flags and what good onboarding looks like.

What usually goes wrong

The most common failure is a close built from the bank feed: revenue is net of fees, package money is income, and the P&L swings with the promotion calendar. Next is the missing count, so cost of goods sold is whatever the supplier was paid that month and injectable margin is noise. Commissions are paid on package sales at the register and never accrued, so provider cost lands a month late and a month off. Sales tax is filed from the POS report without ever reconciling the liability account, or not filed at all because "we are a medical practice." The laser loan payment is expensed in full. Tips and sales tax collected are left in revenue. And the pack arrives on the 25th with no commentary, so a 10% move in injectable margin goes unnoticed until the tax return. Each of these is invisible on a P&L that looks tidy, which is why the deliverable list above matters more than the price.

When to get help

If your monthly pack has no deferred revenue rollforward, no inventory count and no commission accrual, you are paying for categorization rather than a close, and the P&L you are reading measures something other than your practice. Our med spa bookkeeping and monthly close service delivers everything on the list above by the tenth business day, with Jenny Gao, CPA, EA, reviewing every file. It is the bookkeeping layer of Med Spa Core, which adds payroll coordination, retail sales tax filings, quarterly planning and the returns from $1,500 a month, month-to-month after onboarding with thirty days' written notice.

If you want to know what your current bookkeeper is skipping, request a 20-minute fit call and bring last month's P&L, balance sheet and POS outstanding-balance report. We will compare the balance sheet to the POS on the call and tell you which deliverables are missing.

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.