Your clinic just crossed ₹75 lakh. Here is everything that changes

For years your tax life fit in one line: gross receipts × 50%, ITR-4, done. Section 44ADA made a growing practice almost administratively invisible. The day your receipts cross ₹75 lakh, that entire regime switches off at once — and most doctors discover it in March, when the options have already narrowed.

Here is the full map: the two thresholds, what dies at each one, and the checklist for the transition year.

The two thresholds — ₹50 lakh and ₹75 lakh

Section 44ADA lets a notified professional (medicine is one, under s.44AA(1)) declare 50% of gross receipts as presumptive profit — or more, if the actual profit is more — with no books under s.44AA and no audit under s.44AB.

The basic eligibility ceiling is ₹50 lakh of gross receipts. The Finance Act 2023 added a proviso raising it to ₹75 lakh — but only if cash receipts are 5% or less of total receipts (put positively: at least 95% digital — bank, UPI, cards, cheques). Miss the 95% test in a year where receipts are between ₹50L and ₹75L, and you are outside 44ADA for that year: books plus s.44AB audit.

Two structural notes doctors regularly get wrong:

• The 95% test is receipts-based, not patient-based. One ₹4 lakh cash surgery in a ₹70 lakh year can single-handedly breach 5%.
• Only individuals and HUFs get the ₹75 lakh proviso — and LLPs were never eligible for s.44ADA at any threshold.

What switches off above ₹75 lakh

Presumptive assessment. Above ₹75 lakh there is no 44ADA at any digital percentage. You maintain books of account under s.44AA and get them audited under s.44AB — Form 3CB-3CD through a CA, due 30 September (one month before your ITR due date of 31 October for audit cases).

The one-instalment advance-tax privilege. Under the proviso to s.211(1)(b), a 44ADA assessee pays all advance tax by 15 March. Outside 44ADA you are back to the four-instalment calendar — 15 June, 15 September, 15 December, 15 March — with s.234C interest per deferred instalment.

ITR-4. Your form becomes ITR-3, with full P&L and balance-sheet schedules. Filing ITR-4 out of habit invites a defective-return notice under s.139(9).

The penalty for ignoring all this is s.271B: 0.5% of gross receipts for failure to get audited, capped at ₹1.5 lakh — plus the interest that follows recomputed income.

What switches on — the part nobody tells you

Presumptive taxation was convenient, but it taxed you on a deemed 50% margin whether or not your real margin was lower. Books cut both ways:

• Real expenses become claimable: staff salaries, rent, consumables, indemnity insurance, journal subscriptions — deductible under s.37(1) if incurred wholly for the profession.
• Depreciation under s.32: that ₹40 lakh ultrasound machine now depreciates against income; medical equipment generally sits in the 15% plant-and-machinery block. Under 44ADA, depreciation was deemed already allowed — you got no separate benefit.
• A clinic with heavy equipment and real rent can have a true margin well below 50%. For many practices the audit year is the year the effective tax rate falls. Run the comparison before you resent the compliance.

Watch the cash-discipline sections that now bite line-by-line: expenses above ₹10,000 paid in cash are disallowed under s.40A(3), and accepting ₹2 lakh or more in cash from a patient in a single transaction breaches s.269ST (penalty under s.271DA: the entire amount).

The transition-year checklist

• Track the 95% digital ratio monthly from April — not in March. If a large cash receipt is unavoidable, know what it does to the ratio before accepting it.
• Open the books on 1 April of the crossing year: a case register, expense ledger and reconciled bank statements. Reconstructing a year in February is what audit qualifications are made of.
• Fix asset values: for equipment bought during 44ADA years, written-down values are computed as if depreciation had been allowed in those years — get this schedule right once, at entry.
• Recompute advance tax on the four-instalment calendar from the first year outside 44ADA.
• Book the auditor before December. A 30 September deadline met in September is a myth you only believe once.
• Ask the entity question now: at hospital scale, proprietorship vs LLP vs Pvt Ltd changes your rate, your audit burden and your family's participation. That decision is better made a year early than a day late.

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Crossing the threshold this year? Harun Raaj & Associates, Visakhapatnam builds the transition plan — books from 1 April, the 44ADA-vs-books comparison, the audit calendar, and the entity memo — before the year closes around you.

See Also

• Property Capital Gains: Indexation vs 12.5% Tax in 2026
• Section 148A Reassessment: Time Limits & Valid Notice Rules
• Capital Gains on Property Sale AY 2026-27: 12.5% or 20%?

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