Are visco-elastic (memory-foam) mattresses, pillows, and cushions exempt from Colorado sales tax as therapeutic devices if a doctor prescribes them for pain management?
Plain-English summary
A company that makes visco-elastic (memory-foam) mattresses, pillows, and cushions asked whether its products are exempt from Colorado sales tax when sold for pain management with a doctor's prescription. Its line included general mattresses and pillows alongside more clinical-sounding items — a Therapeutic Mattress, Rehab Mattress, Bariatric Mattress, Neonatal Mattress, wheelchair cushion, lumbar cushions, neck pillows, and more — all marketed as relieving back/neck pain and pressure sores.
The Department said most do not qualify. Colorado exempts a therapeutic device, appliance, or accessory worth more than $100 that is sold to correct or treat a physical disability or surgically created abnormality and is prescribed by a doctor (§ 39-26-717(1)(b)). But exemptions are narrowly construed — a transaction isn't exempt unless it clearly falls within the exemption (Security Life & Accident v. Heckers). The Department applied three limits, all from FYI Sales 68:
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Must be primarily/customarily medical. A therapeutic device must be one that is primarily and customarily used for medical purposes and is not useful to a person who isn't ill or injured. Otherwise everyday items — water beds, weight-lifting equipment, ordinary pillows — would become exempt the moment a doctor recommended them. Most of these products are useful to anyone, for years, so they fail this test.
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Treat/cure, not merely prevent. "Therapeutic" implies treatment and curative properties. Items designed primarily to prevent injury (the products' main claim was preventing pressure ulcers) are not in the exemption, even if occasionally used to treat an existing sore. The Department assumed the long useful life of mattresses/pillows meant prevention was their primary purpose.
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Must be a device/appliance (equipment). The exemption covers devices or appliances — i.e., equipment or a mechanism. Soft goods (the letter notes heel protectors, boot cradles, support hose) aren't equipment. The Department couldn't conclude any of the pillows or mattresses clearly qualified as devices.
The Department left a door open: a bed or mattress designed only for medical use with no use except for an injured person can be a therapeutic device. Some product names (Rehab, Therapeutic, Bariatric Mattresses, wheelchair cushion) hinted at that, but the company supplied too little information to decide, so no item was found exempt on this record. (Bariatric/obesity equipment alone, even if sturdier and larger, doesn't qualify unless it's also therapeutic.)
What this means for you
Sellers of mattresses, pillows, cushions, and comfort goods
A doctor's prescription and a "therapeutic" or "rehab" product name do not make a memory-foam mattress or pillow tax-exempt in Colorado. The Department starts from the rule that exemptions are narrow, and it treats items that ordinary, healthy people also buy — and that are used for years — as taxable everyday goods. To have any shot at the exemption, an item must be equipment designed only for medical use, used to treat or cure (not merely prevent) a disability or surgical abnormality, cost over $100, and be prescribed.
If you think a specific item qualifies, document it
The Department repeatedly said it lacked information to evaluate the clinical-sounding products. If you sell something genuinely built only for medical use (e.g., a specialty hospital mattress with no consumer use), put together the engineering/medical documentation showing it treats a condition and isn't useful absent illness — and consider a binding private letter ruling on that single item rather than the whole catalog.
Prevention vs. treatment is decisive
Marketing that an item prevents pressure ulcers, aligns the spine, or improves comfort works against exemption. The exemption is for treating or curing. That distinction sank most of this line.
Common questions
Q: My doctor prescribed a memory-foam mattress for my back — is it tax-free in Colorado?
A: Generally no. The Department treats memory-foam mattresses and pillows as everyday items that are useful to people who aren't ill, so a prescription doesn't make them exempt therapeutic devices.
Q: What actually qualifies as an exempt 'therapeutic device'?
A: Equipment (a device or mechanism) that is primarily and customarily used for medical purposes, isn't useful to a healthy person, treats or cures a disability or surgically created abnormality, costs over $100, and is prescribed by a licensed practitioner.
Q: The product is called a 'Therapeutic Mattress' or 'Rehab Mattress' — doesn't the name help?
A: No. The Department looks at what the item actually is and does, not its name. It said it couldn't find those items exempt without far more information showing they're built only for medical use.
Q: Why does 'prevention' matter?
A: Because "therapeutic" means treating or curing. Items designed mainly to prevent injury (like preventing pressure sores) fall outside the exemption even if they sometimes help treat an existing problem.
Q: Can we rely on this letter?
A: No. It's a General Information Letter — general guidance, not binding on the Department, and the Executive Director did not formally review it.
Citations and references
Statutes, cases, and publications:
- § 39-26-717(1)(b), C.R.S. — exemption for a therapeutic device/appliance/accessory over $100 sold to correct or treat a physical disability or surgically created abnormality, when prescribed by a doctor
- Security Life & Accident Co. v. Heckers, 177 Colo. 455, 495 P.2d 225 (1972) — tax exemptions are narrowly construed; a transaction is exempt only if it clearly falls within the exemption
- Department FYI Sales 68 (Medical and Dental Equipment and Supplies) — a therapeutic "device" is equipment/a mechanism designed for the special purpose of correcting or treating a disability; must be devised for healing, not everyday use
Out-of-state authority the Department cited:
- Florida Technical Assistance Advisement 02A-019 (03/20/2002) (beds designed only for medical use can qualify); Indiana Letter of Finding 05-0299 (02/01/2007) (bariatric equipment not exempt)
Related Colorado medical-exemption letters:
- [[gil-08-004-taxability-of-motorized-scooters-boot-walker-and-soft-shoe]] — scooters and orthopedic boots/shoes taxable; "a device must be equipment"
- [[gil-08-014-taxability-of-medical-equipment]] — LASIK laser/interfaces taxable (consumed by the doctor, don't leave with the patient)
- [[gil-09-022-medical-equipment-sales-tax]]
Source
- Landing page: https://tax.colorado.gov/sales-use-tax-letter-rulings
- Original PDF: https://tax.colorado.gov/sites/tax/files/documents/GIL-08-013.pdf
Original ruling text
Office of Tax Policy
P.O. Box 17087
Denver, CO 80217-0087
[email protected]
GIL-2007-13
XXXXXXXXXXXXXX.
Attn: XXXXXXXXXX
XXXXXXXXXXXXXX
XXXXXXXXXXXXXX
February 14, 2008
Re: Taxability of [name] products
Dear XXXXXXXXX,
This letter is in response to your letter to the Colorado Department of Revenue, dated November 13,
2007, re: taxability of [Company] products.
Issue
Are the products listed below exempt from sales tax if sold for the purpose of pain management with
a physician’s prescription?
Background
The following background is provided in your request. [Company] produces various types of
mattresses and other bedding products containing pressure-relieving material composed of highdensity, visco-elastic, memory cells. The cells are temperature sensitive causing the mattresses and
products to conform to the contours of the body allowing for the person’s weight to be evenly
disbursed. The design makes the mattresses and products are useful in helping people with various
infirmities obtain a restful sleep and are commonly recommended for people with back-pain, neck
pain and pressure sores. The following is a list of products and a brief description.
[name] Mattress – composed of visco-elastic material developed to support the body in
perfect musculoskeletal alignment.
Therapeutic Mattress – composed of visco-elastic material and designed for institutional and
home care environments.
Rehab Mattress - composed of visco-elastic material designed to maximize independence of
the immobile or injured patient.
Bassinet Mattress - composed of visco-elastic material and designed for newborn and
pediatric care.
Bariatric Mattress - composed of visco-elastic material and designed for the specific needs of
bariatric patients for the prevention and treatment of pressure ulcer incidence.
Neonatal Mattress - composed of visco-elastic material and designed to provide comfort and
skin care protection for the neonate.
[name] neck pillow - composed of visco-elastic material in an ergonomically correct shape to
provide maximum support to the neck.
Support pillow – designed to give pressure relieving support to the lumbar area, under the
legs or behind the neck.
Transit Pillow – designed to wrap around the cradle the neck to relieve pressure.
Millennium Pillow – patented design provides neck alignment whether you sleep on your side
or back.
Comfort Pillow – traditional pillow shape with a pressure relieving shell filled with visco-elastic
micro-cushions designed for pressure management.
Classic Pillow – traditional pillow design utilizing [Company] pressure-relieving material.
Body Pillow - similar to the Comfort Pillow mentioned above in a size that supports the
positioning and comfort of an individual’s entire body.
Wheel Chair cushion – designed with pressure relieving material to reduce pressure at the
bony prominences that can result in pressure ulcers.
[name]-Travel Set – includes a Mattress Overlay and Travel Neck Pillow.
Mattress Overlays – the ability to add three inches of pressure-relieving material to any
sleeping surface.
Neck Support Pillow – unique “horseshoe” shape containing pressure-relieving material
designed to cradle the neck to relieve pressure while traveling.
Universal Support Pillow – half-moon shape containing pressure-relieving material designed
to support the lumbar area.
Lumbar Support Cushion – properly supports the mid and lower back.
Home and Office Seat Cushion – distributes weight evenly over its entire surface to help
people sit comfortably for extended periods of time.
Leg Spacer – helps to relieve lower back and hip pain.
Discussion
A therapeutic device, appliance or related accessory, with a retail value of more than one-hundred
dollars, and that is sold to correct or treat a physical disability or surgically created abnormality are
exempt from Colorado sales and use tax if the product is prescribed by a doctor. §39-26-717(1)(b),
C.R.S. However, exemptions such as this are narrowly construed. Transactions are not exempt
unless they clearly fall within the exemption. Security Life & Accident Co. v. Heckers, 177 Colo. 455,
495 P.2d 225, 226 (1972).
The therapeutic devices contemplated in this exemption are those devices that are primarily and
customarily used for medical purposes and are not useful to a person in the absence of injury or
illness. Otherwise, the exemption would expand beyond traditional notions of therapeutic devices to
items of everyday use. Weight lifting equipment, a hot tub / spa, or water bed can be therapeutic.
Indeed, it is undoubtedly the case that a number of mattresses and pillows marketed to the general
public provide in varying degrees improved musculoskeletal alignment and reduce points of pressure
on the skin. A doctor may recommend the use of a water bed, weight-lifting equipment or a common
pillow to reduce pain or prevent pressure sores. However, it would be a contrary to the legal
mandate that we narrowly interpret exemptions to expand this exemption to include everyday
household items simply because a doctor or chiropractor prescribes them. See, Department of
Revenue FYI Sales 68 (“In addition, the item must be devised or constructed for the particular
purpose of healing or curing a human disability or surgically-created abnormality.”).
This is not to say, however, that a mattress or pillow cannot be a therapeutic device. There are
certainly beds and mattresses that are specifically designed only for medical use and typically do not
have use except for a person who is injured. See, e.g., Florida Technical Assistance Advisement
02A-019, 03/20/2002. However, the information provided in your letter and sales brochure suggests
most of the items are commonly used for everyday living and have usefulness to a person who is not
ill or injured. Therefore, and based on the information provided, these items do not qualify as
therapeutic devices.
The names of some products suggest that they might be specially designed and primarily used for
medical purposes, such as the Rehab Mattress, Therapeutic Mattress, Bariatic Mattress, and
wheelchair pillow. However, I cannot draw any conclusions from the scant information provided in the
letter. The literature enclosed with the letter does not discuss these items. I should also note that it is
not sufficient to demonstrate that the pillows or mattresses prevent pressure ulcers, which appears to
be the principal medical claim of a number of the products. Therapeutic implies treatment and
curative properties. Items that do not treat or cure, but are primarily designed to prevent injury are
not included in this exemption. See, Department FYI Sales 68 (“A therapeutic “device” means a
piece of equipment or a mechanism designed to serve the special purpose of correcting or treating a
human physical disability or surgically-created abnormality.”). Given that mattresses and pillows are
useful for many years, I assume that the primary purpose of these items is the prevention of such
ulcers, even though they may be used for a short duration to treat existing ulcers.
Similarly, bariatic equipment, although larger and sturdier, does not, in and of itself, qualify for the
exemption. Equipment specifically designed for obesity does not qualify unless it also therapeutic.
Compare, Indiana Letter of Finding No. 05-0299, 02/01/2007 (Bariatic equipment, designed to be
sturdier and larger, is not exempt because it did not alleviate or correct the patient’s medical condition
of obesity.).
The exemption applies only to devices or appliances (and accessories). A device or appliance
implies equipment. Items such as a heel protector, boot cradle, and support hose are not equipment.
See, Department of Revenue FYI Sales 68. Based on the information provided, I cannot conclude
that any of the pillows or mattresses described above clearly fall within the exemption as devices or
appliances.
Finally, the Department makes a good faith effort to provide accurate and complete answers to
questions posed to it by taxpayers. However, the information and answers provided here are not
binding on the Colorado Department of Revenue, nor do they replace, alter, or supersede Colorado
law and regulations. The Executive Director, who by statute is the only person having authority to
bind the Department, has not formally reviewed and/or approved this response.
Respectfully,
Office of Tax Policy
Colorado Department of Revenue