GST billing for clinics in India: a plain-English guide

Most clinical care a doctor provides is exempt from GST. But the moment a clinic sells products, runs a pharmacy, or crosses the registration threshold, GST shows up on the invoice, and getting it wrong is an audit risk. This guide covers the parts a clinic actually needs.

Is healthcare exempt from GST?

Services by a clinical establishment, an authorised medical practitioner, or paramedics are exempt from GST under the healthcare-services exemption. That covers consultations, diagnosis, and treatment. For the detail, see what's exempt and what isn't and whether consultation fees are taxed.

What is not automatically exempt: over-the-counter pharmacy and product sales, and cosmetic or aesthetic procedures, which since September 2025 are taxed at 5% without input tax credit. If your clinic sells any of these, those line items can attract GST even though consultations don't.

When does a clinic need a GSTIN?

A GST registration (GSTIN) is generally required once aggregate turnover crosses the threshold in the CGST Act. The threshold differs for goods vs services and by state category. A purely exempt practice may not need one; a clinic with taxable product or pharmacy revenue typically does. The full thresholds, and the trap where your exempt consultation income still counts toward them, are in does a clinic need GST registration.

This is general information, not tax advice. Confirm your clinic's position with a chartered accountant. Thresholds and rates change.

CGST + SGST vs IGST on a clinic invoice

Once you're registered and billing a taxable item:

• Same-state patient → the tax splits into CGST + SGST (half each).
• Inter-state patient → a single IGST at the combined rate.

The split is driven by the place of supply, not by what you'd prefer. So the invoice has to know the patient's state.

HSN / SAC codes

Taxable goods carry an HSN code; services carry a SAC code. A compliant tax invoice lists the code against each line item along with the rate. Our guide to HSN and SAC codes covers how to find and apply them.

What a compliant tax invoice must contain

When a clinic bills a taxable line, the document is a tax invoice, and Rule 46 of the CGST Rules sets out what it has to carry. For a clinic, the fields that matter on each invoice are:

• Your clinic's name, address, and GSTIN.
• A consecutive serial number. Up to 16 characters, unique within the financial year (more on numbering below).
• The date the invoice is issued.
• The patient's name and address, plus their GSTIN if they happen to be registered (most patients are not).
• The HSN or SAC code against each line, with a description.
• Quantity for goods (a medicine strip, a consumable).
• The total value, the taxable value after any discount, the rate of tax, and the amount of tax. Shown as CGST + SGST, or as IGST.
• Place of supply with the State name when the patient is from another state (this is what tells the system to use IGST instead of CGST + SGST).
• A signature or digital signature.

You do not need every one of these on a typed receipt to be polite; you need them to be correct if a line is taxable and an auditor ever asks.

Bills of supply for exempt lines

An exempt consultation is not billed on a tax invoice at all. There is no tax to show. Under Rule 49 it goes on a bill of supply, which carries most of the same identity fields (your name, address, GSTIN; a serial number; the date; the patient's details; the SAC code and description; the value) but no tax rate and no tax amount, because none applies. A registered clinic that hands over an exempt service should mark it accordingly rather than dressing it up as a taxed line. That is exactly why the mixed bill below splits across two documents.

Sequential, per-clinic invoice numbering is not cosmetic. The serial number has to be consecutive and unique within the financial year, so a multi-branch clinic typically runs a separate, gap-free series per branch (often a branch prefix). Gaps or duplicates are the first thing a GST audit looks for, because they suggest a missing or re-used invoice.

A worked example: one mixed bill

Say a same-state patient pays for a consultation and picks up a medicine strip at the counter. The two lines are taxed differently, so they belong on two documents even when you hand them over together:

Line	Treatment	Amount	GST	Patient pays
Consultation	Exempt (bill of supply)	₹500	—	₹500
Medicine strip 5%	Taxable (tax invoice)	₹200	₹10 = CGST ₹5 + SGST ₹5	₹210
Total		₹700	₹10	₹710

The consultation carries no tax and goes on a bill of supply. The medicine is taxable, so its ₹10 splits into CGST ₹5 + SGST ₹5 for a same-state patient (it would be a single IGST of ₹10 if the patient were from another state). The exempt line is unaffected by the taxable line sitting next to it.

How Avinya Plus handles this

In Avinya Plus, each service or product in your catalogue carries its own price, tax rate, and HSN/SAC code. Once your clinic has a GSTIN, tax auto-splits into CGST+SGST for same-state patients or IGST for inter-state ones, and you print an A4 tax invoice or an 80mm thermal receipt. No manual tax math at the counter.