NDIS Pricing Guide Split: What Providers Need to Know
This episode breaks down the NDIA’s move from a single pricing PDF to three separate documents, explaining how the Annual Pricing Review, Pricing Schedule, and Support Catalogue now work together. It also covers tight provider margins, reduced therapist travel billing, legacy code traps, and why regular compliance checks are now essential.
Chapter 1
The Death of the One Stop NDIS Price Guide
Will, EnableUs Community
So, if you, if you go looking for that big, monolithic PDF on your computer, you know, the one we all kept in that messy desktop folder called NDIS stuff, well, as of one July twenty twenty six, that search is basically a recipe for an instant claim rejection. The NDIA did this, um, this pretty radical thing. They completely shattered the single, one hundred page billing bible we all used to rely on into three entirely separate documents.
Winter, EnableUs Community
Wait, three? Why would they make it more complicated? We already have enough, like, digital clutter to sift through every single day.
Will, EnableUs Community
Exactly, but, uh, they split it up to separate the policy reasoning from the daily tools. So now, instead of one giant file, we have the Annual Pricing Review, which is basically the why, containing all the research and market data. Then you have the NDIS Pricing Schedule, which lists the actual maximum rates and support names. And finally, the NDIS Support Catalogue, which is the how, where you find all the active line codes and specific rules.
Winter, EnableUs Community
So the actual, um, the actual codes and the rates are no longer in the same document? That sounds like a massive multi tab headache for anyone trying to put an invoice together.
Will, EnableUs Community
Oh, it, it absolutely is. If you want to check if a provider can bill for therapist travel, for example, you can't just look up the rate. You have to open the Pricing Schedule to find the maximum dollar amount, and then cross reference that with the Support Catalogue to see the specific travel billing rules for that exact support type. It turns a quick five second check into a high stakes scavenger hunt.
Winter, EnableUs Community
That is wild. And if your software system hasn't updated to match this three document split, you are going to get hit with so many rejected claims. It, it really forces you to be hyper vigilant about what is active versus what has been archived or made a legacy code.
Will, EnableUs Community
Yes, legacy codes are a major trap. The NDIA converts old codes to legacy before deactivating them completely. If you claim against a deactivated code, it is an automatic system reject.
Chapter 2
The Tight Margins and the Hidden Addendum
Will, EnableUs Community
This actually brings us to the actual numbers, because the margins for providers are, um, they are incredibly tight right now. Take weekday Assistance with Daily Life. The NDIS maximum rate is seventy dollars and twenty three cents per hour. But under the SCHADS Award, providers have to pay support workers between thirty one dollars and eighteen cents and forty three dollars and sixty six cents per hour.
Winter, EnableUs Community
Forty three dollars and sixty six cents? That, that really doesn't leave much of a gap when you factor in things like superannuation, training, insurance, and just keeping the office lights on.
Will, EnableUs Community
It really doesn't. That gap has to cover all your overheads. And it gets even trickier for therapists. Since the recent updates, therapists can now only charge travel at fifty percent of their hourly rate instead of one hundred percent. It makes home and school visits much harder to justify financially, and some are stopping travel services altogether.
Winter, EnableUs Community
That is a massive blow for participants in regional areas who rely on those visits. It, it really shows how these tiny pricing tweaks have huge, real world consequences.
Will, EnableUs Community
It does. And there is one more document providers often overlook, but it is incredibly important. It is called the Bereavement Addendum. It is the specific document that outlines exactly what you can claim if, tragically, a participant passes away.
Winter, EnableUs Community
Oh, wow. I, I didn't even realize that was a separate document. That must be incredibly tough to navigate when you are already dealing with a loss.
Will, EnableUs Community
It is, but knowing those rules prevents both underclaiming for services you already delivered and, um, making non compliant claims during a really difficult time. That is why staying on top of this is so critical. Best practice is to set a monthly calendar reminder, say, the first business day of every month, to check the NDIA pricing page at ndis dot gov dot au slash providers for any mid year updates, like the version one point one update we saw on twenty four November twenty twenty five. It is the only way to keep your business sustainable and compliant.
Winter, EnableUs Community
Mm, definitely. Well, that is a lot of homework for this month. Let us go update those bookmarks.