Payroll is the largest cost in a med spa and the one most often paid from a spreadsheet. The payroll provider does its part well: it calculates withholding, deposits the taxes and files the returns. What it cannot do is read the production report in Aesthetic Record or Boulevard, know that a package sold this week has not been redeemed, or tell you that the nurse practitioner you pay on a 1099 looks like an employee. That is the work on this page.
Who runs payroll, and who makes it tie
Gusto, ADP, Paychex and QuickBooks Payroll all run payroll competently once the inputs are right. The inputs in a med spa are the problem: a commission figure that someone calculated from a POS export, tips that were paid out in cash and never reached the payroll record, a retail commission that was lumped into service commission, an owner who took draws instead of a salary. We set the earnings codes so each element is separately recorded, deliver the commission file every pay period with its support, and at month end tie the payroll registers to QuickBooks Online so wages, employer taxes, tips payable and the commission accrual agree with the returns the provider filed.
Commission plans that tie to the production report
Most practices pay injectors a base plus a percentage of what they produce, and the plan is only as good as the definition of produce. In our practice we recommend commissionable revenue mean services actually performed, net of the product used, excluding sales tax, tips and gift-card sales, and that package and membership treatments count when they are redeemed rather than when they are sold. Paying on sales means paying a provider for a treatment the practice still owes the patient, and sometimes paying twice when a different provider performs it. The same definition drives the month-end accrual, so provider cost sits in the month the revenue was earned and gross margin by provider means something.
| Pay element | Source | Payroll earnings code | QuickBooks Online account |
|---|---|---|---|
| Base pay (hourly or salary) | Schedule or time records | Regular | Provider wages |
| Service commission | POS production by provider, net of product cost, excluding tax and tips | Commission | Provider commissions |
| Retail commission | POS product sales by provider | Retail commission | Retail commissions |
| Tips | POS tip report | Paycheck tips | Tips payable (pass-through) |
| Owner-injector salary (S corporation) | Reasonable compensation set in tax planning | Officer salary | Officer compensation |
| Medical director fee | Agreement and monthly invoice | Not payroll: accounts payable, Form 1099 | Medical director fees |
An illustrative example with round numbers: an injector is paid a $70,000 base plus 10% of commissionable service revenue and 5% of retail she sells. Her production report for the month shows $60,000 of services performed, of which $10,000 were package redemptions, plus $8,000 of new package sales and $5,000 of retail. Product used on her services cost $18,000. Commissionable service revenue is $60,000 less $18,000, or $42,000, so her service commission is $4,200; retail commission is $250. The $8,000 of package sales earns nothing until redeemed. If her plan had paid on gross sales, the practice would have paid $800 this month for treatments not yet delivered and would have no clean way to avoid paying again at redemption. The $4,450 goes to the payroll provider under two earnings codes, and the portion earned after the last pay date of the month is accrued at close.
W-2 or 1099: injectors and medical directors
The IRS decides this on behavioral control, financial control and the type of relationship, not on what the contract says. An injector who works your schedule, in your rooms, on your patients, with your product, at a price you set, is an employee under the IRS common-law test in most fact patterns, and treating her as a contractor without a reasonable basis makes the practice liable for the employment taxes. A medical director who runs an independent practice, sets his own hours, carries his own malpractice coverage and supervises several facilities usually is an independent contractor, often paid through a professional corporation. Where the facts are close we tell you so and point you to Form SS-8 or to employment counsel; we do not give legal advice.
Contractor payments bring their own filing. For payments made in 2026 the Form 1099-NEC threshold is $2,000, and the forms are due to the recipient and the IRS by February 1, 2027. The usual exemption for payments to corporations does not apply to medical and health care payments, so a medical director fee paid to a professional corporation is tracked for Form 1099-MISC box 6 rather than ignored. Payments you make by credit card are reported by the card processor on Form 1099-K, not by you, so the method of payment has to be tracked by vendor from the start of the year.
Payroll taxes and registrations, in plain terms
The provider deposits and files, but you should know what it is filing. Social Security tax is 6.2% from the employee and 6.2% from the practice on wages up to $184,500 in 2026; Medicare is 1.45% each with no cap. Federal unemployment is effectively 0.6% on the first $7,000 of each employee's wages once the state credit is applied. In Florida a new employer pays reemployment tax at 2.7% on the first $7,000 of each employee's wages, reported quarterly on Form RT-6, and the rate moves with experience after that. Florida also requires new-hire reports for employees and, since October 1, 2021, for independent contractors, and non-construction employers with four or more employees must carry workers' compensation. We open the accounts, file the reports and flag each threshold before a hire crosses it. W-2s for 2026 are due to employees and the Social Security Administration by February 1, 2027.
A provider in another state
A second location across a state line, or an injector who lives in Georgia and works in Florida two days a week, adds state withholding and unemployment registrations and sometimes local taxes. The trigger is where the work is performed, not where the practice is incorporated. We identify the states, open the accounts and set each provider's work location in the payroll provider before the first check, then watch the monthly production report for a provider who has started splitting time between locations. For the planning side of provider pay, see our guides on injector compensation and commission payroll, employee versus independent contractor and 1099-NEC for medical directors and contractors.