Performance Max for healthcare advertisers

Performance Max is the Google Ads campaign type that runs one campaign across Search, YouTube, Display, Discover, Gmail and Maps. You supply goals, text, images, video and audience signals, and Google’s systems decide where the ads run, who sees them and which combination of your assets to show. For a medical practice, that trade raises two questions: which controls you keep, and which Google health and privacy rules still decide what the campaign can do.

This guide covers the controls Google lists for Performance Max, the audience signals a health advertiser can and cannot use, generated text and landing pages, and the patient data and tracking limits that apply. For related topics, see our guides to targeting healthcare ads by age, sex, race and language, uploading patient lists to ad platforms and why healthcare ads get disapproved. For the campaign type built around image and video placements, see our guide to Demand Gen campaigns for healthcare advertisers. What Google and Meta allow for retargeting health services is in our guide to healthcare remarketing ads. Waze ads now run through Performance Max; see Waze ads for medical practices.

This is general information, not legal advice. Sources cited were checked on November 1, 2026: the Google Ads Help pages About Performance Max campaigns, Search targeting and controls for Performance Max (with its pages on search themes, negative keywords, brand exclusions and Final URL expansion), Negative keywords in Performance Max campaigns, About account-level negative keywords, How asset groups work, About audience signals for Performance Max campaigns and Key Google Ads policies that may impact your Performance Max campaigns (no date shown on these pages); the Google Ads policies on Healthcare and medicines, Health in personalized advertising and the Customer Match policy (no date shown); the HHS OCR bulletin on online tracking technologies (content last reviewed June 26, 2024, with its note on American Hospital Association v. Becerra); 45 CFR 164.501, 164.502(a) and 164.508(a)(3); and 15 USC 45(a)(1) and 52. Google changes these pages without notice, so check the current versions before you launch. We found no federal rule or agency guidance written for Performance Max campaigns by medical practices as such. State rules differ, so have a health care attorney review your advertising.

The short version

Performance Max serves one campaign across Google’s inventory. You set the goal, budget and assets, and Google picks placements, audiences and ad combinations.
Your controls include account-level and campaign negative keywords, brand exclusions, search themes, URL inclusion and exclusion rules, and the choice to turn text customization and Final URL expansion on or off.
Negative keywords and brand exclusions in Performance Max act on Search and Shopping inventory, not on YouTube, Display or Gmail placements.
Audience signals are suggestions. Google says Performance Max may show ads to people outside your signals.
If your ads fall in Google’s Health sensitive interest category, you cannot use advertiser-curated audiences such as Customer Match, your data segments or lookalike segments, and Google tells advertisers to remove them from asset groups too.
Google says you remain responsible for landing page content and for each asset it generates for you.
HIPAA limits on patient lists and on tracking tags apply no matter which campaign type you choose.

What Performance Max does

Google’s help page describes Performance Max as a goal-based campaign type that gives access to all Google Ads inventory, including YouTube, Display, Search, Discover, Gmail and Maps, from a single campaign. You define conversion goals, provide text, images and video in asset groups, and can add audience signals. Google’s systems then bid in each auction based on the predicted chance of a conversion and mix your assets into ads for each placement.

The page also says that when a search query matches an exact match keyword in one of your Search campaigns, that Search campaign is prioritized over Performance Max. Search themes carry the same priority as phrase and broad match keywords. A practice that wants tight control over a short list of searches, such as its own name plus “appointment”, can keep those as exact match keywords in a separate Search campaign.

Channel prioritization, as Google describes it, lets you set priority tiers across inventory. Google groups Search, YouTube, Maps, Gmail and Discover together as “Google channels”, and search partners and the Google Display Network can get separate priority tiers and optional daily budget allocations. That is the closest control the page lists to choosing where the ads appear.

The controls you keep

Google’s guide Search targeting and controls for Performance Max lists keywordless targeting, Final URL expansion, search themes, negative keywords and brand exclusions. Here is what each one does, as Google describes it.

Negative keywords. You can add negative keywords to a Performance Max campaign or at the account level. Google’s page on account-level negative keywords says that list applies to the search and shopping inventory of Search, Performance Max, App, Shopping, Smart and Local campaigns, allows up to 1,000 negative keywords per account, and that negative keywords do not match close variants. If you exclude “flowers”, a search for “red flower” can still show your ad. Google also notes that Performance Max negative keywords apply to Search and Shopping inventory only.

Brand exclusions. Google recommends brand exclusions rather than negative keywords to keep Performance Max off searches for your own brand or a competitor’s, and says they also block misspellings and variants of the brand name. In Performance Max they apply to Search and Shopping ads. For the separate question of bidding on other practices’ names, see our guide to bidding on competitor names in search ads.

Search themes. Search themes are words and phrases that describe what your patients search for. Google treats them as a signal to its keywordless targeting, not as keywords that limit where the ad shows, and its page suggests adding up to 50.

Final URL expansion and URL rules. With Final URL expansion on, Google may send a searcher to a different page on your site than the one you chose and write a matching headline and description. You can add URL exclusions, such as pages containing /blog or a single exact URL, but Google says URL exclusions are available only when Final URL expansion is turned on. With it off, ads go to the final URLs you set.

Text customization and generated assets. Text customization, formerly called automatically created assets, lets Google write additional headlines and descriptions from your landing page, domain and existing ads. If you do not upload a video, Google says one may be generated from your other assets. The About Performance Max campaigns page states that you remain responsible for reviewing and ensuring the compliance and accuracy of landing page content and all dynamically generated assets.

Why generated text matters for a practice

A practice’s ad claims are subject to the FTC Act. 15 USC 45(a)(1) declares unfair or deceptive acts or practices unlawful, and 15 USC 52 makes it unlawful to disseminate a false advertisement likely to induce the purchase of services or cosmetics. A headline that Google writes from your landing page is still your ad. If your blog says a treatment “may help” and a generated headline drops the qualifier, the ad states something you did not write and may not be able to support.

Google’s page on key policies for Performance Max also warns that generative AI may display inaccurate content and says not to rely on generative AI features in Google Ads for medical advice. It says Google’s AI is designed not to automatically suggest generated images for sensitive verticals such as pharmaceutical ads, and that all generated content is held to the same ad policies as content you upload.

No federal rule we found requires a practice to turn text customization or Final URL expansion off. We recommend turning both off for a practice whose site includes clinical content, patient education or condition pages, or else excluding those pages with URL rules and reviewing the asset report on a set schedule. Keep a record of what you reviewed and when.

Health ad policies that still apply

Performance Max does not change Google’s healthcare rules. The Healthcare and medicines policy restricts, among other things, prescription drug services such as online pharmacies and telemedicine providers that prescribe, prescription drug terms in ads, landing pages and keywords, speculative and experimental treatments including cell and gene therapies, clinical trial recruitment and addiction services. Prescription drug services and addiction services are among those that require Google certification before the ads can run. Ads that pass with limits are labeled “Eligible (limited)” and run only where allowed.

Because Performance Max can use your landing pages and site to build ads, a restricted term on a page you did not pick as a final URL can still reach a generated asset or an expanded URL. For how disapprovals work and how to appeal, see our guide to why healthcare ads get disapproved.

Audience signals and the Health category

Google’s page on audience signals says they are optional suggestions that help its AI optimize, and that Performance Max may show ads to relevant audiences outside your signals if they have a strong likelihood of converting. The inputs it lists are your own data (website visitors, app users, customer lists and video viewers), custom segments built from keywords, URLs or apps, demographics, and Google’s segments for detailed demographics, life events, affinity and in-market status.

The Health in personalized advertising policy narrows that list for health advertisers. It defines Health as a sensitive interest category that includes physical or mental health conditions, products, services or procedures to treat or manage chronic conditions, health issues associated with intimate body parts or functions, invasive medical procedures including cosmetic surgery, surgical procedures or injections, and disabilities. For ads in this category, advertiser-curated audiences cannot be used. The policy lists Customer Match, your data segments, audience expansion and lookalike segments as advertiser-curated. Predefined Google audiences such as in-market, affinity and life events can be used, because Google says sensitive user signals are automatically excluded from them.

Two details matter for Performance Max. First, the policy’s fix instructions tell advertisers to remove advertiser-curated audiences and to check the targeting settings of ad groups, asset groups and campaigns. Audience signals live in asset groups. Second, a footnote says custom segments using sensitive creative assets or pointing to sensitive landing pages will serve only with Display campaigns to non-sensitive audiences or contextually, and that other campaigns using such custom segments will not be eligible to serve. The same policy says users under 18 are not eligible for personalized ads of any kind.

Whether a given ad falls in the Health category is Google’s call, made from the ad, the keywords and the landing page. An ad for injectables, a chronic condition program or behavioral health counseling fits the examples Google gives. For age, sex and other demographic targeting in health ads, see our guide to targeting healthcare ads by age, sex, race and language.

Patient lists and Customer Match

Google’s Customer Match policy says you may upload only customer information collected in a first-party context, your privacy policy must disclose that you share customer data with third parties to perform services on your behalf, you must obtain consent where required by law, and you may not upload information about anyone under 13. Separately from the Health category limits above, the policy sets account eligibility rules and a 540-day membership limit for list entries.

For a HIPAA covered entity, the list itself is the larger question. Using protected health information to encourage patients to buy a service is marketing under 45 CFR 164.501, 45 CFR 164.502(a) permits uses and disclosures only as the Privacy Rule allows, and 45 CFR 164.508(a)(3) requires the patient’s written authorization for marketing, with narrow exceptions. A list of patients uploaded to an ad platform tells the platform that each person is a patient of your practice. Our guide to uploading patient lists to ad platforms covers this in detail.

Conversion tracking and health data

Performance Max optimizes toward the conversion actions you set, which means a Google tag on your site or imported conversions. That raises the questions covered in our guide to tracking pixels on practice websites.

The HHS Office for Civil Rights bulletin on online tracking technologies is still posted, with a note. On June 20, 2024, in American Hospital Association v. Becerra, the US District Court for the Northern District of Texas vacated the bulletin to the extent it said HIPAA obligations are triggered when a technology connects an IP address with a visit to an unauthenticated public page about specific health conditions or providers. The rest of the bulletin stands, including its guidance on authenticated pages such as patient portals. We recommend keeping tags off patient portals, appointment request confirmations and pages that would reveal a visitor’s condition, and counting a conversion from a page that shows only that a form was sent, without the reason for the visit.

Questions to ask before your practice runs Performance Max

Which conversion action will the campaign optimize for, and does the tag that records it sit on any page that reveals a condition or sits behind a login?
Will text customization and Final URL expansion be on or off, and who reviews generated headlines and expanded URLs?
If Final URL expansion stays on, which pages have we excluded, such as the blog, condition pages and the patient portal?
Do our ads fall in Google’s Health category, and have we removed Customer Match lists, our data segments and lookalike segments from each asset group?
Does a custom segment point to a sensitive landing page or use sensitive assets?
Is our account-level negative keyword list in place, and are brand exclusions set?
Does any landing page use prescription drug terms or describe a service Google restricts, and do we hold the certification it requires?
Can we substantiate each claim in our assets, including the ones Google may combine in new ways?

Use and avoid

Use: an account-level negative keyword list for services you do not offer and searches you do not want.
Use: brand exclusions if a separate Search campaign covers your practice name.
Use: URL exclusions for the blog, condition pages and the portal, or turn Final URL expansion off.
Use: predefined Google segments and search themes as signals for health ads.
Use: a dated record of the assets you approved and the generated assets you reviewed.
Avoid: uploading patient lists as audience signals without a written HIPAA authorization from each patient.
Avoid: remarketing lists of site visitors as signals for ads in the Health category.
Avoid: headlines that promise outcomes, even if you only wrote the landing page they came from.
Avoid: conversion tags on pages that show a condition, a booked service or portal content.

An illustration

This example is invented. [Practice name], a med spa in [city], sets up a Performance Max campaign for injectable treatments with [budget] a day. The first draft uses the practice’s client email list and a site visitor list as audience signals, leaves text customization and Final URL expansion on, and counts a conversion when the booking confirmation page loads, which names the treatment booked.

Before launch, the owner reviews the setup with their marketing contact. Because injections fall in Google’s Health category, both lists come out of the asset group, and the signals become search themes and a predefined in-market segment. Final URL expansion stays on with exclusions for the blog and the treatment risks page. Text customization is turned off so headlines come only from copy the owner approved. The conversion moves to a generic thank-you page that does not name the treatment. The owner adds an account-level negative keyword list for services the practice does not offer and saves a dated copy of each asset.

Checklist

Confirm whether your ads fall in Google’s Health sensitive interest category.
Remove Customer Match lists, your data segments and lookalike segments from asset groups for health ads.
Check custom segments for sensitive assets or landing pages.
Decide on text customization and Final URL expansion, and write the decision down.
Add URL exclusions for pages you do not want used as landing pages.
Set account-level negative keywords and brand exclusions.
Check landing pages for restricted drug terms and services that need Google certification.
Review the asset report for generated headlines and descriptions on a set schedule.
Move conversion tags off pages that reveal a condition or sit behind a login.
Get written HIPAA authorization before any patient information goes to an ad platform.
Keep dated records of settings, approved assets and reviews.

How we help

We build websites, local and organic search, Google Ads and lead generation and an AI front desk for independent practices. For Performance Max, that means setting the controls Google offers, keeping health ads to the audiences Google allows, writing assets the practice can substantiate and setting up conversion tracking that leaves health details out. Our tools are built with HIPAA in mind. We confirm in writing what a BAA covers before any patient information flows through a tool, and if it is not covered, we do not route patient information through it. We are not a healthcare provider and we do not give legal or medical advice. Read our guide to healthcare marketing rules for the wider picture.

Can a medical practice use Performance Max?

We found nothing in Google’s Performance Max pages that bars healthcare advertisers. The Healthcare and medicines policy, the personalized advertising rules for the Health category and the Customer Match policy apply to it as they do to other campaign types, and certain services need Google certification first.

Can we use our patient list as an audience signal?

Google’s Health in personalized advertising policy says advertiser-curated audiences, including Customer Match, cannot be used for ads in the Health category, and it tells advertisers to check asset groups. Under HIPAA, using patient information for marketing also needs each patient’s written authorization under 45 CFR 164.508(a)(3), with narrow exceptions.

Can we stop Performance Max from showing on certain searches?

Yes. Campaign and account-level negative keywords block matching queries on Search and Shopping inventory, and brand exclusions keep the campaign off searches for brands you list. Google notes negative keywords do not match close variants, so add the variants you want blocked.

Who is responsible for headlines Google writes for us?

You are. Google’s About Performance Max campaigns page says you remain responsible for reviewing and ensuring the compliance and accuracy of landing page content and all dynamically generated assets. You can turn text customization off.

Do audience signals limit who sees our ads?

No. Google says audience signals are optional suggestions and that Performance Max may show ads to relevant audiences outside your signals when they are likely to convert. Use location settings, negative keywords and brand exclusions for limits.

Google Performance Max for healthcare advertisers: what you can and cannot control