Medical practices & clinics
Books and taxes for vein clinics.
Insurance-covered ablations for symptomatic veins, cash-pay sclerotherapy for cosmetic spider veins, and diagnostic ultrasound billed on its own. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
June came in at $38,300. Shorts and swimsuit season pushed cosmetic sclerotherapy bookings up, so I kept that revenue apart from the insurance-covered ablation cases.
- Availity batch depositAblation procedure reimbursements
- Sclerotherapy package, NakamuraCosmetic sclerotherapy revenue
- Duplex ultrasound reimbursementsDiagnostic ultrasound fees
- VenaCure laser console leaseAblation equipment
- Clinical staff payrollClinical wages
Why your books are different
A vein clinic's books go wrong where medically necessary meets cosmetic.
A symptomatic varicose vein treated with ablation is billed to insurance, while a cosmetic spider vein treated with sclerotherapy is almost always paid in cash, and both often happen in the same exam room on the same day. A generalist blends the two and loses track of which side of the practice is actually driving revenue.
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1
Ablation and cosmetic sclerotherapy get blended together
An insurance-covered ablation for a symptomatic vein and a cash-pay sclerotherapy series for cosmetic spider veins run on completely different margins and payment timing, but they can look identical on a bank statement if not labeled.
What we doKeeps ablation reimbursements and cosmetic sclerotherapy revenue in separate lines, so you can see which side of the practice is actually carrying the month. -
2
Diagnostic ultrasound bills separately from the procedure
A duplex ultrasound used to diagnose and map a vein before treatment often pays out as its own line item, separate from the ablation or sclerotherapy procedure it leads to.
What we doKeeps diagnostic ultrasound reimbursements in their own line, so a batch of imaging payments doesn't get mistaken for a random deposit unrelated to procedures. -
3
Cosmetic sclerotherapy packages get spent before they're delivered
A patient who prepays for a series of sclerotherapy sessions to treat spider veins hands you the money up front, but the sessions happen over weeks or months.
What we doKeeps prepaid sclerotherapy package revenue visible as its own line, separate from single sessions, so a package sale doesn't overstate one month. -
4
Ablation equipment reads as a supply run
A laser or radiofrequency ablation console can cost as much as a small practice's annual rent. Filed as supplies, it wrecks the month it was bought and hides what it's worth over years.
What we doFlags a big equipment purchase the day it lands, logs it as equipment, and lets the accountant decide how it gets written off.
Your categories
The categories Gus keeps for a vein clinic.
Set up once for how ablation cases, cosmetic sessions, and imaging all get paid. You never pick a category. He does, and an accountant checks it.
Money in
- Ablation procedure reimbursementsInsurance deposits for medically necessary varicose vein treatment.
- Cosmetic sclerotherapy revenueCash-pay spider vein treatment, kept apart from insurance-covered cases.
- Diagnostic ultrasound feesDuplex ultrasound imaging used to diagnose and map veins before treatment.
- Prepaid treatment packagesSclerotherapy session series paid up front.
Money out
- Ablation equipmentLaser and radiofrequency consoles, logged so they get written off right.
- Ultrasound equipmentDiagnostic imaging machines used for vein mapping.
- Sclerotherapy suppliesSclerosant agent, compression garments, and injection supplies.
- Clinical wagesNurses and vascular technicians, kept apart from provider compensation.
- Malpractice insuranceAnnual or quarterly premiums for the practicing physicians.
- Rent and utilitiesThe procedure rooms and imaging space.
- Marketing for cosmetic servicesAdvertising that drives cosmetic sclerotherapy bookings.
What we watch for you
- Medical versus cosmetic mix
How much of each month comes from insurance-covered ablation versus cash-pay cosmetic sclerotherapy.
- Package revenue owed
How much prepaid sclerotherapy package money still represents sessions not yet delivered.
- Imaging revenue share
How much diagnostic ultrasound brings in apart from the procedures it leads to.
- The set-aside
What you will owe, tracked every month, so April is a number you already knew.
Ask Gus
Things vein clinic owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
I keep cosmetic sclerotherapy revenue apart from insurance-covered ablation, so you can see the real trend instead of guessing from the total.
Yes, diagnostic ultrasound often pays out separately from the procedure it leads to, sometimes on a different schedule. I keep it in its own line so it doesn't look unexplained.
Usually it can. I logged it as equipment, not supplies, and flagged it so the accountant makes the call with your whole year in view.
The tax side
The tax side of a vein clinic.
Most of what matters here is separating medical from cosmetic revenue and knowing where the pass-through deduction starts to phase out.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- The pass-through deduction phases outA vein clinic can lose part or all of the 20 percent pass-through deduction once taxable income passes $201,750 single or $403,500 joint, since medical practices are a specified service trade.
- Ablation and ultrasound equipmentLaser and radiofrequency ablation consoles and diagnostic ultrasound machines can usually be written off the year you buy them, with 100 percent bonus depreciation available for property acquired after January 19, 2025.
- Sclerotherapy supplies and inventorySclerosant agent and injection supplies are generally deductible as ordinary business expenses in the year they are used.
- Contract or covering physiciansA physician covering your clinic occasionally who bills you directly is often a contractor and gets a 1099-NEC if you pay them $2,000 or more in 2026, due January 31.
Deductions vein clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- Sclerotherapy supplies
- Ablation equipment maintenance
- Ultrasound equipment servicing
- Malpractice premiums
- CME courses and travel
- Board certification renewal
- Compression garments and supplies
- Practice management software
- Marketing for cosmetic services
- Scrubs and clinical apparel
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A vein clinic year, kept every month.
Cosmetic bookings pick up before shorts and swimsuit season while ablation cases run steadier year round. Your taxes come on a fixed schedule. Your team keeps you ahead of both. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and you get a monthly set-aside so April is already handled, even with cosmetic and medical revenue on different rhythms.
- April
Filed. Done.
Your return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where you stand, what you will owe, and whether summer cosmetic bookings matched last year's pattern.
- October
Before year end
Gus looks at equipment worth buying and anything worth doing before December, as cosmetic bookings usually taper for the season.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for vein clinics. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions vein clinic owners ask first.
Do you bill insurance for ablation procedures?
No. Gus does not handle insurance billing, medical coding, or claims of any kind. Your practice management software or billing service still does that. Gus works from what actually lands in your bank account.
How do you keep our medical and cosmetic revenue straight?
By the payer the deposit came from. Insurance-covered ablation and cash-pay cosmetic sclerotherapy are kept in separate lines from the start.
Diagnostic ultrasound seems to bill separately from procedures. Is that a bookkeeping problem?
It's normal for this specialty. Gus keeps ultrasound revenue in its own line so it doesn't look like an unexplained deposit unrelated to your procedures.
A patient prepaid for a sclerotherapy series but stopped after two sessions. What happens to that money?
Gus keeps prepaid package revenue tracked separately from earned revenue. What to do about an unfinished package is a policy call for you and your accountant.
Cosmetic bookings pick up hard every summer. Is that a concern for the books?
No, it's a normal pattern for this specialty. Gus tracks cosmetic revenue against the same season last year, so the summer surge reads as expected.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever