Top Cost Segregation Firms For Medical Office Buildings In 2027

Compare 10 medical office cost segregation firms for 2027, from engineering specialists to healthcare CPA firms, with case studies, pricing and practice fit.

Medical office buildings often produce stronger cost segregation results than standard offices. Exam and procedure casework, medical gas lines, specialty plumbing, imaging power and shielding, nurse-call cabling and procedural lighting can qualify as shorter-life property when they are owned and documented. This list is for physicians, dentists, practice groups and healthcare real estate investors weighing a medical office cost segregation study. It also covers dental office cost segregation, since many of the same firms serve both. If you are new to the topic, start with our guide on how cost segregation works.

For cost segregation for medical office buildings, we selected firms that publish medical office, dental or healthcare case studies or service pages, explain their engineering approach, and support clients after the study. The list includes engineering specialists, national CPA firms with healthcare practices, and flat-fee providers for smaller practices.

The rule to know for 2027: the One Big Beautiful Bill Act, signed July 4, 2025, made 100% bonus depreciation permanent for qualifying property acquired and placed in service after January 19, 2025. Buildings acquired on or before that date stay on the old phase-down, which reaches 0% for property placed in service in 2027. Results depend on your dates and whether you own the building, the build-out or both, so confirm with your CPA.

Medical Office Cost Segregation Firms At A Glance

Company	Headquarters	Best For	Standout
Engineered Tax Services	West Palm Beach, FL	Physician and dental owners nationwide	Large library of medical and dental case studies
KBKG	Pasadena, CA	Owners wanting an independent specialist	Medical office, hospital and veterinary case studies
CliftonLarsonAllen (CLA)	Minnesota LLP, 120+ locations	Healthcare organizations and practice groups	Dedicated health care cost segregation practice
Forvis Mazars	National CPA firm	Healthcare systems and larger owners	Hundreds of healthcare cost seg and energy studies
R.E. Cost Seg	Houston, TX	Smaller medical buildings and dental offices	Medical office guide and virtual inspections
Cost Seg Smart	Los Angeles, CA	Single practices wanting a fixed price	Published medical and dental price tiers
Leyton	International (US practice)	Owners who prefer to pay after delivery	Medical office case studies, no upfront retainer
EisnerAmper	National CPA firm	Imaging centers and surgical build-outs	Healthcare facility case examples with 179D coordination
Source Advisors	Arlington, TX	Medical office and clinic investors	ASCSP-certified professionals
Withum	Founded in Milltown, NJ	Practices already using a national CPA firm	Publishes a 20% to 40% medical office range

Best Medical Office Cost Segregation Firms In 2027

1. Engineered Tax Services — Licensed Engineering Firm With Deep Medical And Dental Case Files

Engineered Tax Services (ETS) was founded in 2001 by Julio Gonzalez and is based in West Palm Beach, Florida, with offices in cities including Dallas, Charlotte, Los Angeles, New York and Phoenix. It describes itself as a licensed engineering firm specializing in tax strategies, with engineers, tax attorneys and CPAs on staff.

ETS publishes a wide set of healthcare case studies: medical office buildings in Charlotte, North Carolina, and Broken Arrow, Oklahoma; a medical-dental office in Cheyenne, Wyoming; and dental offices in Grand Prairie, Texas, Surprise, Arizona, and Belmont, New Hampshire. In the Grand Prairie dental clinic study, about 33% of basis moved to 5-year property and about 10% to 15-year property.

The firm also offers 179D and R&D credit work, which can help owners who build or renovate clinical space.

Best for: Physician and dentist owners who want a specialist with many comparable studies.

2. KBKG — Independent Specialist With Medical Office And Hospital Studies

KBKG was established in 1999 and lists offices in Los Angeles, New York, Atlanta, Chicago, Dallas, Detroit and Houston. It says it is not owned by or affiliated with any CPA firm, and its team includes engineers, attorneys and former IRS engineers. Several principals hold the CCSP credential.

Its case study library covers general and medical office, hospitals and medical centers, assisted living, and veterinary facilities. A published KBKG study on medical office improvements in Denton, Texas, shows a large share of the improvement cost placed in 5-year property, which reflects how clinical build-outs often perform.

For properties under $1.5 million excluding land, KBKG points owners to CostSegregation.com, its self-guided software, which can suit a small practice condo.

Best for: Owners and CPAs who want an independent, audit-focused firm with a software option for small buildings.

3. CliftonLarsonAllen (CLA) — Health Care Cost Segregation Practice Within A National CPA Firm

CLA is a national accounting firm with more than 120 US locations and a dedicated health care cost segregation practice. Its studies combine a tax and engineering perspective, with engineering staff reviewing construction invoices and plans, on-site inspections with photos, and allocation of indirect construction costs.

CLA lists physician’s office buildings, dental offices, ambulatory surgery centers, hospitals, medical facilities, senior living and skilled nursing among the properties it studies. It also handles studies on past acquisitions and improvements, claiming missed depreciation in the current year.

For healthcare organizations that already use CLA for audit or tax work, keeping the study in-house simplifies coordination.

Best for: Physician groups, surgery centers and healthcare organizations that want a CPA firm with a health care focus.

4. Forvis Mazars — Engineers And Accountants For Healthcare Real Estate

Forvis Mazars is a national accounting firm with about 7,000 team members. Its healthcare cost segregation work uses an engineering-based approach that draws on construction costs, plans, property records and site visits, and it lists medical offices among the healthcare real estate types it serves.

The firm cites a team of engineers, construction management and accounting professionals with experience on hundreds of healthcare cost segregation and energy studies. It notes that healthcare buildings are often good candidates for Section 179D energy studies as well, although the 2025 law cut 179D back for projects that begin construction after June 30, 2026.

Fees are quoted individually.

Best for: Health systems, larger practice groups and investors with several medical buildings.

5. R.E. Cost Seg — Virtual Inspections For Medical And Dental Buildings

R.E. Cost Seg is a Houston firm founded in 2022 that publishes a medical office building guide and serves physician groups and medical developers. It reports more than 20,000 properties and studies completed.

Its guide lists the components that usually drive results: specialty lighting and high-capacity electrical, medical cabinetry, imaging infrastructure and shielding, infection-control HVAC, specialty plumbing, gas lines and owner-funded tenant improvements. The firm says its engineering-based studies typically reclassify 40% to 50% of a medical office building’s basis, and cites a $9 million multi-specialty facility with more than $1.1 million in first-year deductions.

Fully Engineered Studies start at $2,730 for commercial properties, with inspections usually by video call. It also supports Form 3115 look-back filings with your CPA.

Best for: Owners of single medical or dental buildings who want a lower-cost engineered study.

6. Cost Seg Smart — Fixed-Price Studies For Medical And Dental Practices

Cost Seg Smart is a Los Angeles provider with a dedicated medical and dental office page. It lists studies from $2,995 for a basis under $1 million and $4,995 for a typical $1 million to $3 million practice, although the site shows lower figures in other places, so confirm the current quote.

The firm explains which clinical fit-out items are usually 5-year property when owned and documented: exam and procedure casework, medical gas, scrub sinks, imaging power and cooling, nurse-call cabling and procedural lighting. It estimates a typical reclassification of 16% to 29% of building basis. Practices that paid for a clinical build-out in leased space can order a tenant-improvement study.

Studies arrive as CPA-ready PDFs with depreciation schedules, lifetime written audit support and a CPA-Ready Guarantee. Most are remote; larger projects may include on-site observation.

Best for: Single-location physicians and dentists who want a fixed price and a fast report.

7. Leyton — Engineering Studies With No Upfront Retainer

Leyton is an international tax consultancy whose US practice reports more than 10,000 cost segregation studies. Studies are led by engineers, construction analysts and tax professionals, can run remotely or in person, and usually take four to eight weeks. Clients pay after delivery, with no upfront retainer.

Leyton publishes a medical office case study on a 6,000 square foot building with a $2.4 million basis, where about 27% of basis moved into 5, 7 and 15-year classes. Its Texas page cites a $2.2 million Houston medical office building with about $253,000 reclassified.

The payment model limits risk for practice owners who are unsure whether a study will pay off.

Best for: Medical office owners who want an engineered study without paying until it is delivered.

8. EisnerAmper — Healthcare Facility Studies Coordinated With Renovation Planning

EisnerAmper is a national accounting and advisory firm with more than 4,500 professionals. Its Real Estate Services Group publishes guidance on cost segregation for healthcare facilities, focusing on medical office buildings and veterinary facilities.

The firm says healthcare studies often reclassify about 20% to 40% of a facility’s assets, with imaging centers and surgical suites driving many reclassifications. One example it cites is an imaging center renovation of about $2.1 million, where more than 30% moved to 5-year property. EisnerAmper also coordinates cost segregation with qualified improvement property, Section 179D and the tangible property regulations during renovations.

That coordination is useful for practices planning build-outs or expansions.

Best for: Imaging centers, surgical practices and owners planning major renovations.

9. Source Advisors — ASCSP-Certified Studies For Medical Offices And Clinics

Source Advisors is based in Arlington, Texas, and cites more than 40 years in the cost segregation industry. It says its team includes ASCSP-certified professionals, with engineers and tax professionals separating building components. A typical study takes about eight weeks.

Medical office, medical clinic, hospital, pharmacy and assisted living are all on the firm’s list of building types. Source Advisors works with many accounting firms and says it supports clients if the IRS examines a study.

Its intake asks whether the building or renovation cost exceeds $500,000, so it is better suited to full buildings than to small office condos.

Best for: Investors and practice owners with medical buildings or clinics above $500,000 in cost.

10. Withum — National CPA Firm With Published Medical Office Ranges

Withum opened in Milltown, New Jersey, in 1974 and now has about 3,200 team members across 30 offices. Its cost segregation service covers new construction, acquisitions, expansions and remodels, plus look-back studies, repair studies and Section 179 studies.

Withum publishes potential reallocation ranges by property type and lists medical offices at 20% to 40%, with tenant improvements at 10% to 50%. That gives practice owners a realistic starting point before ordering a study.

It suits physicians and dentists who already use Withum for practice accounting and want the study handled alongside their federal and state returns. Withum also offers look-back studies for buildings bought in earlier years, and repair studies that can help when a practice renovates exam rooms or upgrades equipment rooms.

Best for: Practices that want their national CPA firm to run the study.

How To Choose A Medical Office Cost Segregation Firm

Do You Own The Building, The Build-Out Or Both?

Owners of the building can study the whole property. Tenants who paid for their own clinical build-out may still benefit from a tenant-improvement study. Tell each firm exactly what you own so the scope is right.

Has The Firm Studied Clinical Space Before?

Medical gas, imaging rooms, shielding and specialty plumbing need someone who recognizes them. Ask for medical or dental case studies at a similar size.

Is The Study Engineering-Based And Audit-Ready?

Ask who performs the inspection, whether a site visit or video walkthrough is included, and whether audit defense is part of the fee.

Can Your CPA Use The Deductions?

Passive activity rules can limit how physicians use losses from a building they lease to their own practice. Ask your CPA how the deductions flow before ordering a study, or consult one of the firms on our list of real estate CPA firms for investors.

Does The Fee Fit The Benefit?

Fees range from fixed prices for small practices to custom quotes for large buildings. Ask for a benefit estimate before you sign.

Frequently Asked Questions

How Much Of A Medical Office Building Can Be Reclassified?

Firms on this list publish ranges from about 16% to 50% of basis. Buildings with imaging suites, surgical rooms and heavy clinical build-out tend to land higher than general medical office space.

Can A Tenant Do A Cost Segregation Study?

Yes, if the tenant paid for the improvements. The study covers the owner-funded build-out rather than the building shell.

Can I Study A Building I Bought Years Ago?

Yes. A look-back study claims missed depreciation in the current year through a change in accounting method on Form 3115, without amending earlier returns. Your CPA should confirm.

Does 100% Bonus Depreciation Apply In 2027?

Under the 2025 law, qualifying property acquired and placed in service after January 19, 2025 qualifies for permanent 100% bonus depreciation. Property acquired earlier follows the old phase-down, which is 0% for property placed in service in 2027.

Conclusion

Engineered Tax Services and KBKG bring the largest medical office case files, CLA, Forvis Mazars, EisnerAmper and Withum suit owners who want a CPA firm with healthcare experience, and Cost Seg Smart and R.E. Cost Seg offer clear pricing for single practices. Ask each firm for a benefit estimate and confirm how your CPA will use the deductions. For a wider view of the market, see our roundup of top commercial cost segregation firms.

This article is general information, not tax or legal advice.