What makes this industry different
Dental and medical practices share a few things that change which card fees matter:
- Larger bills. A treatment plan or a procedure can run to hundreds or thousands of dollars.
- Payments later. Some charges are made after the visit, from a card kept on file, or as part of a payment plan.
- Health care categories. In the US, Visa has its own rates for health care merchants.
A merchant category code (MCC) is a four-digit code that says what kind of business you are. Card networks use it to decide some rates and rules. Your processor can say which code your practice has.
Fees to know about in this industry
United States: Visa’s healthcare rates. Visa’s US rules define a “Health Care Merchant” as “A Merchant, other than a pharmacy, whose primary business is providing health care services” and that uses one of 16 listed MCCs. The list includes 8011 (Doctors and Physicians), 8050 (Nursing and Personal Care Facilities), 8062 (Hospitals) and 8099 (Medical Services and Health Practitioners).
Visa’s US rate sheet (rates effective April 18, 2026) has “Healthcare” rows that apply to sales of $500 or more:
| Visa US consumer credit card | Healthcare, in person (“Healthcare 2”) | Healthcare, card not present (“Healthcare 1”) | General in-person row (“Product 2”) |
|---|---|---|---|
| Traditional Rewards | 1.43% + $0.05 | 1.53% + $0.05 | 1.65% + $0.10 |
| Visa Signature | 1.43% + $0.05 | 1.53% + $0.05 | 1.65% + $0.10 |
| Visa Signature Preferred | 2.30% + $0.10 | 2.40% + $0.10 | 2.10% + $0.10 |
| Visa Infinite (spend qualified) | 2.30% + $0.10 | 2.40% + $0.10 | 2.30% + $0.10 |
These are interchange rates: what your processor pays your patient’s bank. Visa’s sheet says merchants pay a “merchant discount” to their financial institution instead. More: What Is Interchange?
Canada: no doctor or dentist program. Visa Canada’s rate sheet has industry programs for gas, grocery, everyday needs and utilities, and an “Emerging Segments” program. None lists doctors or dentists. Emerging Segments includes MCC 8050: Nursing and Personal Care Facilities, at 0.98% for a Classic card. Other clinics fall under the standard rates, such as 1.25% for a Classic card in person (“Electronic”) and 1.40% card not present.
Interac debit (Canada). Interac’s Tier 1 tap rate of $0.020 a sale (up to $100) includes Hospitals (MCC 8062) and Nursing and Personal Care Facilities (MCC 8050). Most other clinics fall under Tier 3 at $0.035. Tap sales from $100.01 to $250 are $0.055 for everyone. See Interac Debit: How It Is Priced.
US debit. A federal rule, Regulation II, caps debit interchange at 21 cents plus 0.05% of the sale for card issuers with $10 billion or more in assets. The rule is being challenged in court, and the cap stays in force while an appeal is pending. See US Debit Fees: Regulation II (Durbin).
Average ticket and why it matters
Your average ticket is your average sale: card sales divided by the number of card sales. Clinics with larger bills feel the percentage more than the cents.
The per-sale cents matter less on large bills. On a $1,200 sale, 25¢ is about 0.02% of the sale. See Per-Transaction Fees.
Card on file and payment plans
Charging a saved card later is a card-not-present sale. Published rates for these are often higher than in-person rates:
| Provider or network | In person | Card on file or card not present |
|---|---|---|
| Square Canada | 2.5% (credit) | 3.3% + 15¢ |
| Square US (Free plan) | 2.6% + 15¢ | 3.5% + 15¢ |
| Helcim markup (Tier 1) | Interchange + 0.40% + 8¢ | Interchange + 0.50% + 25¢ |
| Visa US healthcare, Traditional Rewards | 1.43% + $0.05 | 1.53% + $0.05 |
Visa’s US sheet also lists “Recurring” rates for card-not-present payments, such as 1.53% + $0.05 on a Traditional Rewards card. Helcim says its recurring transactions “in most cases will qualify for discounted interchange rates from the card-networks”, and lists recurring billing at +0.4% per transaction. More on storing cards and recurring charges: Card on File and Recurring Payments.
Equipment and software options
Many practice management systems connect to a card processor. Each provider lists its own terminals and software prices. See Equipment Leases and the provider pages for Helcim and Square.
Contract terms to read closely
- Monthly fees. See Statement and Monthly Fees.
- Disputes on charges a patient does not recognize. See Chargebacks.
- Card security. Storing card details brings PCI duties. See PCI Fees and Non-Compliance Fees.
- Surcharges in Canada. See Surcharging Credit Cards in Canada.
Questions to ask a processor
- Which merchant category code will my practice have?
- In the US: do my sales of $500 or more qualify for Visa’s healthcare rates?
- What rate applies when I charge a card on file?
- How are recurring payment plans priced?
Where to go from here
On a statement, card-on-file and in-person sales are often listed apart, each with its own rate. How to Read Your Merchant Statement shows where they sit. Country hubs: Canada and the United States.
Want a partner to review your statement? We will put you in touch. Start the free statement review.