Key fact: In 2026 there is no difference between "factura de honorarios" and "recibo de honorarios" — they are the same CFDI 4.0. What matters: if you are a doctor, your CFDI must say exempt (not 0% rate); and if you are in RESICO, your client should withhold only 1.25% ISR, not 10%.
Who issues professional fee invoices and under which regime
The professional fee invoice (CFDI 4.0 income receipt) is issued by any individual providing professional services independently — without an employment relationship with the client. This includes doctors, lawyers, accountants, architects, engineers, psychologists, consultants, designers and any independent professional.
| Regime | SAT code | ISR on income | Withholding by corporate client | Deduct expenses |
|---|---|---|---|---|
| Business and Professional Activities | 612 | 1.92%–35% on actual profit | 10% ISR + 10.67% IVA | Yes |
| RESICO (Simplified Trust Regime) | 626 | 1%–2.5% on collected income | 1.25% ISR + 10.67% IVA | No |
IVA matrix by professional type: who charges it, who doesn\'t, and why
| Professional | IVA on CFDI | Legal basis | Important note |
|---|---|---|---|
| General practitioner / specialist | Exempt | Art. 15 Sec. XIV IVA Law | Only if service is provided directly with professional license |
| Dentist | Exempt | Art. 15 Sec. XIV IVA Law | Same as doctor; requires license |
| Clinical psychologist | Exempt | Art. 15 Sec. XIV IVA Law | With psychology license; clinical services |
| Hospital / clinic (legal entity) | 16% | Art. 1 IVA Law | Legal entity does not qualify for exemption |
| Lawyer / notary | 16% | Art. 1 IVA Law | Legal services always taxed |
| Accountant / auditor | 16% | Art. 1 IVA Law | Accounting and tax services taxed |
| Architect / engineer | 16% | Art. 1 IVA Law | Projects and consulting taxed |
| Services to foreign client | 0% (export) | Art. 29 Sec. IV IVA Law | Client outside Mexico, payment from abroad |
The critical difference between "exempt" and "0% rate" in the CFDI
When a doctor issues their CFDI with 0% IVA instead of Exempt, the invoice looks the same to the patient — but to SAT, the difference is significant. A 0% rate implies a taxed activity with zero transfer; Exempt implies a non-taxed activity. SAT can detect the inconsistency between the doctor\'s registered activity (exempt) and the CFDIs issued (0% rate), triggering information requests. Additionally, a doctor with exempt activity cannot credit the IVA paid on their own expenses — not with Exempt and not with 0% rate.
Calculation with withholdings: complete example for regime 612 and RESICO
Assume you are a lawyer invoicing $15,000 MXN + IVA to a company (legal entity):
| Item | Regime 612 | RESICO (626) |
|---|---|---|
| Fees invoiced | $15,000 | $15,000 |
| IVA invoiced (16%) | $2,400 | $2,400 |
| CFDI total | $17,400 | $17,400 |
| ISR withheld by client | $1,500 (10%) | $187.50 (1.25%) |
| IVA withheld by client | $1,601.28 (10.67%) | $1,601.28 (10.67%) |
| Net you receive | $14,298.72 | $15,611.22 |
| Advantage of RESICO | — | +$1,312.50 per invoice |
The withheld ISR and IVA are remitted by the client to SAT on your behalf. You declare them as received withholdings in your monthly return and deduct them from your ISR or IVA due. They are not lost money — they are an advance payment to your account.
SAT product/service codes by professional type
| Profession | SAT code | Description |
|---|---|---|
| General medical consultation | 85121502 | Primary medical care services |
| Medical specialties | 85121600 | Specialist physician services |
| Dentistry | 85122000 | Dental services |
| Psychology | 85141600 | Mental health services |
| Legal / lawyers | 80131500 | Legal services |
| Accounting / auditing | 80121600 | Accounting services |
| Architecture / design | 81101500 | Architecture services |
| Civil / structural engineering | 81101600 | Engineering services |
| Business consulting | 80101500 | Business consulting services |
| Graphic design | 87141700 | Graphic design services |
Nexoconsult advises doctors, lawyers, accountants and independent consultants in Mexico on the most suitable tax regime, correct CFDI issuance and tax optimization. View plans and pricing here.
Frequently asked questions
Do medical fees carry 0% IVA or are they IVA-exempt? What's the practical difference in the CFDI?
Medical services provided by a licensed healthcare professional are IVA-EXEMPT — they do not carry a 0% rate. The difference is not semantic: in CFDI 4.0, "exempt" and "0% rate" are different fields with completely different fiscal consequences. When the CFDI says "exempt": the client pays no IVA, the doctor does not charge it, and the client cannot credit any IVA (because none was paid). When the CFDI says "0% rate": the client also pays no IVA in that transaction, but technically the doctor is registering a zero transferred tax, which could allow the client to credit related expense IVA. Issuing with 0% rate when exempt is required generates inconsistencies in the SAT system and can trigger audits. The legal basis is Article 15, Section XIV of the IVA Law: direct professional medical services are exempt when provided by a licensed health professional — including general practitioners, specialists, dentists, and licensed psychologists. Not exempt: clinics and hospitals as legal entities (they do charge IVA), and cosmetic or wellness services without medical prescription.
What ISR withholding applies from my client if I'm in RESICO instead of regime 612?
This is one of the most important and least-known differences. When a legal entity (SA de CV, private hospital, company) pays you professional fees, the ISR withholding that applies depends on your fiscal regime: (1) Regime 612 (Business and Professional Activities): the client withholds 10% of the gross fee amount (Art. 106 LISR). If you invoiced $10,000, you receive $9,000 net. (2) RESICO (Régimen Simplificado de Confianza, code 626): the client withholds only 1.25% of the gross amount (Art. 113-J LISR). If you invoiced $10,000, you receive $9,875 net. The difference in this example is $875 MXN per invoice — with multiple invoices to legal entities in a month, this can be significant. The RESICO professional must indicate their fiscal regime in the CFDI. If the client does not identify them as RESICO and applies 10% withholding, the professional has the right to request a refund of the excess withheld or credit it in their monthly return.
What CFDI use code (UsoCFDI) should I indicate when issuing a professional fees invoice?
The CFDI use code is chosen by the recipient (your client), not by you as the issuer. However, it is common for you to capture it on your client's behalf. The most frequent uses for professional fee invoices: D01 — Medical, dental and hospital expenses: only for individual patients who want to deduct them in their personal annual return. Only applies when the recipient is an individual and the service is medical or dental. G03 — General expenses: for companies and individuals paying professional fees (consultants, lawyers, architects) as a business deductible expense. S01 — No fiscal effects: when the client is an individual who does not need to deduct the expense. The most frequent combination: medical fees to individual patients → D01. Fees to companies → G03. A common error is the doctor capturing D01 for invoices issued to legal entities (hospitals, insurers) — that use code does not apply to legal entities; they should use G03 or whichever applies.
Can I invoice professional fees to an individual who doesn't give me their RFC?
Yes. When the client is an individual who does not provide their RFC, CFDI 4.0 allows using the generic RFC XAXX010101000 for the general public. In that case, you also capture: Recipient name: "PÚBLICO EN GENERAL"; Recipient postal code: same as yours (the issuer's); CFDI use: S01 (No fiscal effects). This type of CFDI is issued under the "Sales to the general public" regime and can be presented in simplified form. The limitation is that an invoice to the general public (XAXX010101000) does NOT serve for the client to deduct the expense in their personal return — for that, they need to provide their actual RFC. If the patient or client wants the invoice for personal deduction (medical fees under D01), they must provide their RFC, full name and fiscal postal code exactly as they appear on their constancia de situación fiscal.
Is there a difference between a "factura de honorarios" and a "recibo de honorarios" in 2026?
No — they are the same document. The term "recibo de honorarios" was the name SAT used before the CFDI era for the voucher issued by independent professionals. Since the CFDI implementation, both the "factura" and the "recibo de honorarios" are the same Digital Tax Receipt (CFDI 4.0) of type "Ingreso" (Income). The actual difference is in the issuer's fiscal regime and service description: a doctor issues a CFDI describing the medical service with IVA exempt. A consultant issues a CFDI describing their professional service with 16% IVA. Colloquially, professionals still call their services invoice a "recibo de honorarios," but before SAT it is exactly the same document: CFDI version 4.0, voucher type "I" (Income), fiscal regime 612 or 626 (RESICO).