Med spa bookkeeping built for how a medical spa actually works.
General bookkeepers close your books monthly and call it done. They don't reconcile Allergan invoices to treatment volume. They don't separate deferred package revenue. They don't track device ROI. Spa Ledger does all three, every week, for $599/month.
No onboarding fee. 30-day satisfaction guarantee. Full refund if not satisfied after the first month.
Med spa bookkeeping requires three things a general bookkeeper cannot handle: injectable COGS reconciliation against Allergan, Galderma, and Merz invoices; deferred revenue separation for prepaid packages and memberships; and device ROI tracking per financed machine. Without these three, your P&L overstates injectable margin by 15 to 20 percentage points and misrepresents quarterly revenue. Spa Ledger handles all three weekly, not monthly.
What your current bookkeeper is getting wrong.
Injectable margin is overstated by 15-20 points
Allergan, Galderma, and Merz invoices sit in email. They're not matched to treatment volume in your POS. Your QuickBooks shows 80% injectable gross margin. The real number, after per-unit COGS, is closer to 60 to 65 percent.
Package revenue is recognized when collected, not when earned
Prepaid packages and memberships are booked as revenue at collection. Your Q1 looks strong. Your Q2 looks soft. Neither is accurate until deferred revenue is separated from earned revenue on a service-delivered basis.
Device lease cost is invisible in the P&L
The Morpheus8, CoolSculpting, or laser lease payment sits in a generic expense line. You cannot see which device is covering its cost and which is quietly losing money every month it sits underbooked.
General bookkeeper vs. med spa bookkeeping.
Most practices pay $200 to $600/month for a bookkeeper who treats their practice like a retail store. Here is what that gap costs them.
| What your books need | General bookkeeper | Spa Ledger |
|---|---|---|
| Injectable COGS reconciliation (Allergan, Galderma, Merz) | Not done — invoices categorized as generic supplies | Weekly, matched to treatment volume per vendor |
| Deferred revenue for prepaid packages and memberships | Revenue booked at collection — GAAP non-compliant | Separated at service delivery, not cash receipt |
| Weekly P&L by service line | Monthly close only — no service-line breakdown | Every Monday by noon — neurotoxins, fillers, laser, body, retail |
| Device ROI per financed machine | Lease payment in rent or equipment expense — invisible | Break-even utilization and negative-equity flag per device |
| Provider profitability | Not calculated — providers appear as a single labor line | Revenue per injector vs. fully loaded cost including consumables |
| MSO/PC two-entity structure | Single-entity books — intercompany fees untracked | Separate books per entity, consolidated reporting included |
| POS reconciliation (Zenoti, AestheticsPro, Mindbody, Boulevard) | Manual CSV import once a month at close | Weekly reconciliation, POS to accounting file |
Every deliverable, every week.
Delivered every Monday by noon. Built on your existing QuickBooks Online or Xero file. One location per subscription.
Weekly P&L by service line
Neurotoxins, fillers, laser, body, facials, and retail split out. Margin by category, not a single lump revenue number.
Injectable COGS reconciliation
Allergan, Galderma, Merz, Evolus, and Revance invoices matched to treatment volume from your POS. Real margin, not assumed margin.
Deferred revenue separation
Packages, memberships, and gift cards separated from earned revenue. Your P&L reflects services delivered, not cash collected.
Device ROI tracking
Break-even utilization, cost per treatment, and a negative-equity flag for every financed device on your floor.
Provider profitability
Revenue per injector against the fully loaded cost of that provider, including consumables, room time, and their share of support staff.
MSO/PC two-entity handling
Management company and professional corporation each get their own books. Intercompany fees and consolidated reporting included.
Live dashboard
Labor percentage, device break-even, injectable margin, and cash position. Updated daily at spaledger.co/dashboard.
Monthly owner snapshot
One-page report on what changed, what to watch, and a specific observation about your practice numbers. Not a generic template.
Two ways to pay. Same service.
Standard monthly
- All 8 weekly deliverables
- One location
- No onboarding fee
- 30-day satisfaction guarantee
Annual prepay
- All 8 weekly deliverables
- One location
- No onboarding fee
- Prorated refund if you cancel
Additional locations: $599/month each. Multi-location consolidated reporting included at no extra cost.
The numbers you should be tracking every week.
Source: AMSPA 2025 State of the Medical Spa Industry Report. Injectable margin benchmarks based on Spa Ledger client data.
Med spa bookkeeping guides.
Med Spa Chart of Accounts
The exact account structure a medical spa needs in QuickBooks Online or Xero — injectables, devices, and deferred revenue separated from day one.
Read guide →POS vs. Bookkeeping: What Vagaro and Mindbody Don't Track
Your POS tracks revenue. It doesn't track COGS, deferred revenue, or device ROI. Here's what falls through the gap every month.
Read guide →Med Spa Bookkeeper vs. CFO: What's the Difference?
A bookkeeper closes the books. A CFO closes the books and tells you what to do about the numbers. This is what the CFO layer costs and what it returns.
Read guide →Injectable Gross Margin: The Real Number
How to calculate true neurotoxin and filler margin after Allergan, Galderma, and Merz COGS — and why most P&Ls overstate it by 15 to 20 points.
Read guide →Deferred Revenue in a Medical Spa
How prepaid packages, memberships, and gift cards should be recorded in QuickBooks — and why booking them at collection overstates your quarterly revenue.
Read guide →Med Spa Profit Margin Benchmarks 2026
EBITDA benchmarks by revenue tier, labor percentage targets, and the margins that separate profitable practices from ones that look profitable.
Read guide →Med spa bookkeeping questions.
What makes med spa bookkeeping different from regular bookkeeping?
Medical spa bookkeeping requires three things a general bookkeeper cannot handle correctly: injectable COGS reconciliation against Allergan, Galderma, and Merz invoices at the treatment level; deferred revenue separation for prepaid packages and memberships; and device ROI tracking per financed machine. General bookkeepers book revenue at collection and ignore vendor invoice matching. That produces a P&L that overstates injectable margin by 15 to 20 percentage points and inflates quarterly revenue from packages not yet delivered.
What does Spa Ledger's med spa bookkeeping include?
Weekly P&L by service line (neurotoxins, fillers, laser, body, facials, retail), injectable COGS reconciliation against vendor invoices, device ROI tracking per financed machine, deferred revenue separation, provider profitability, MSO/PC two-entity handling, a live dashboard, and a monthly owner snapshot report. All built on your existing QuickBooks Online or Xero file. $599/month for one location.
Which POS systems do you work with?
Zenoti, AestheticsPro, Mindbody, Boulevard, and PatientNow. We reconcile your POS export to your accounting file weekly. You do not need to change software. If your system exports to CSV, we can map it.
How is med spa bookkeeping priced?
$599/month for one location, billed monthly. Annual prepay is $499/month ($5,988/year). No onboarding fee. 30-day satisfaction guarantee — full refund if not satisfied after the first month. Additional locations are $599/month each.
How quickly can you clean up existing books?
Onboarding takes 48 hours on our end once you grant QuickBooks Online or Xero accountant access. Your first weekly P&L arrives within 7 to 10 days. Most practices are current within the first month regardless of how far back the books need to go.
Do you handle the MSO/PC two-entity structure?
Yes. The management services organization and professional corporation each get their own books, their own chart of accounts, and their own P&L. Intercompany management fees, profit distributions, and consolidated reporting are included in the standard scope.
Know your real injectable margin by next Monday.
Onboarding takes 48 hours on our end. Your first weekly P&L lands within 7 to 10 days. No onboarding fee. 30-day satisfaction guarantee — full refund if not satisfied after the first month.
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