The ROI Multiplier: 2026 Bonus Depreciation and the Return of R&D Expensing

For clinical entrepreneurs using Medigy to evaluate new aesthetic lasers, surgical robotics, diagnostic tools, and EHR systems, 2026 brings a meaningful tailwind. Recent federal tax changes have made it easier to accelerate deductions tied to capital investment and innovation.

If you are a specialty surgeon or aesthetic practice owner, your technology roadmap is no longer just an operations decision. Done correctly, it can also be a deliberate tax-planning lever.

100% Bonus Depreciation is Back and Permanent

The headline change for 2026 is the return of 100% bonus depreciation for most qualifying property. Under the phase-down schedule that had been in effect, bonus depreciation would have declined to 20% in 2026. Instead, the new law restored full first-year expensing for eligible purchases placed in service under the updated rules.

For high-capital assets you might be comparing on Medigy, such as imaging equipment, advanced aesthetic platforms, surgical hardware, and certain software, this can create a real cash-flow effect. A larger first-year deduction can reduce taxable income immediately, freeing up liquidity that would otherwise be paid out over multiple years.

Practical note: the benefit is driven by placed-in-service timing and eligibility rules, not just the purchase date. Documentation matters.

Section 179 Remains the Workhorse for Smaller Stacks, with Higher 2026 Limits

While bonus depreciation can handle large equipment purchases, Section 179 remains a primary tool for more targeted investments, especially when you want more control over which assets you expense.

For tax years beginning in 2026, the Section 179 expensing limit is $2,560,000, and it begins phasing out once total qualifying purchases exceed $4,090,000.

This is particularly relevant for the digital infrastructure layer, including certain software and technology that often gets evaluated alongside clinical equipment. Examples include EHR, RCM tooling, cybersecurity, and related practice systems. When structured correctly, Section 179 can support a modernization plan while reducing current-year tax exposure.

Practical note: Section 179 has more limitations than bonus depreciation, including taxable-income constraints. The best approach is often a coordinated mix rather than an all-or-nothing decision.

Section 174A Supports a Friendlier Posture Toward Domestic R&D

For surgeons and clinical operators doing genuine development work, such as building proprietary protocols, developing software workflows, creating specialized surgical guides, or iterating on internally developed tools, Section 174A meaningfully changes the economics.

After the 2022 shift that forced many R&D costs into multi-year amortization, Section 174A restored the ability to immediately deduct domestic research and experimental expenditures. Elections may be available depending on the taxpayer’s strategy. In plain terms, qualifying innovation spending can once again be treated more like an immediate operating investment instead of a slow-release deduction.

Practical note: the win here is real, but it lives or dies on classification and substantiation. Clear project tracking, consistent expense coding, and defensible support for what qualifies are essential.

Defensible Financials Determine Whether You Keep the Benefit

Capturing these 2026 benefits is not just about buying the asset. It is about proving the treatment. That means clean fixed-asset records, clear placed-in-service support, consistent bookkeeping, and for R&D, disciplined cost tracking.

Marc Pamatian, founder of Chief Bookkeeping Officer, often emphasizes a simple principle: clean books are the first line of defense when deductions get scrutinized. A specialized med spa bookkeeping or accounting can help ensure accelerated deductions are properly supported, so the tax benefit strengthens your growth plan instead of creating audit risk.