NDIS 2026 Pricing Gap: New Codes, Old Rules

Will, EnableUs Community

So, I, I, I was looking through the NDIS pricing updates page the other day, and we have a situation where providers are literally out on a wire right now. They are claiming for non-face-to-face work, which is totally legitimate, but they are doing it in this weird regulatory void. Like, if you got an audit today, the NDIA could claw back every single dollar if you cannot point to a valid rule set. And we are talking about serious money being recovered as debt years down the line.

Winter, EnableUs Community

Wait, how, how can there be a void? I mean, the new financial year started on the first of July 2026. Didn't they just, you know, release the new pricing guidelines like they always do?

Will, EnableUs Community

They, they did, but here is the catch. This year, the NDIA completely split the old system in two. On the first of July 2026, they published the Pricing Schedule, which has all the new dollar limits, and they released the Support Catalogue, which has the item codes. But as of the eighteenth of July 2026, they have not actually published the updated 2026 to 2027 Pricing Arrangements and Price Limits rules document. It, it is just missing.

Winter, EnableUs Community

Wait. So they, they gave us the prices and the codes, but not the actual rules on how or when we can use them? That is like, okay, it is like getting a brand-new 2026 map showing all these new roads, but having to use the 2025 traffic manual to figure out if you are allowed to turn left or, or who has right of way. Is that what providers are doing? Just guessing with the old manual?

Will, EnableUs Community

That is exactly what is happening, Winter. It is the only defensive strategy right now. You have to use the new 2026 to 2027 prices, but you have to apply the 2025 to 2026 PAPL rules for things like travel, cancellations, and especially non-face-to-face claims. If you do not explicitly follow and document that you are using those 2025 to 2026 rules as your working reference, you are exposing yourself to massive retrospective compliance risks.

Winter, EnableUs Community

Right. Because if they audit you in three years and say, hey, why did you bill thirty minutes of non-face-to-face support here, you cannot just say, oh, well, we assumed it was fine. You need to show the exact paper trail. But what about support coordinators? Because their rules are always a bit, uh, different, right?

Will, EnableUs Community

Oh, support coordinators are in an absolute danger zone right now. The 2026 to 2027 Pricing Schedule does not contain any specific rules for support coordination when it comes to non-face-to-face claims, travel, or short-notice cancellations. Nothing. It is complete silence. So if you are a support coordinator, you absolutely must continue applying the 2025 to 2026 rules, and you have to write down, like literally document, your decision-making process for every single claim to show you were acting in good faith based on the only available guidance.

Winter, EnableUs Community

Okay, so beyond the rules gap, what about the actual, you know, the technical side of how we bill? I heard they got rid of the old checkboxes in the portal.

Will, EnableUs Community

Yes, the old claim-type flags are completely dead for Allied Health and Therapy. From the first of July 2026, if you are billing under Schedules 4 or 5, you have to use these specific suffix codes. So, instead of ticking a box for non-face-to-face, you actually have to select an item code that ends in underscore NF. If it is travel, it is underscore PT. Cancellations are underscore CA. Reports requested by the NDIA are underscore RR. And then telehealth is underscore TH. It, it is a total technical overhaul.

Winter, EnableUs Community

Underscore NF for non-face-to-face and underscore TH for telehealth. But wait, what if you are doing a phone check-in with a client? Is that telehealth because it is over the phone, or is it non-face-to-face because you are doing care coordination? That feels like a massive gray area.

Will, EnableUs Community

It is. It is a huge regulatory gap. The NDIA has not published any guidance on where the line is between telehealth underscore TH and non-face-to-face underscore NF. So if you are doing phone check-ins, the safest bet is to contact the NDIA, get something in writing for your specific situation, and use that as your shield. Do not just guess.

Winter, EnableUs Community

Yeah, because guessing gets you audited. But even if you use the right code, underscore NF, doesn't that all fall apart if the client hasn't actually agreed to it beforehand? Like, I know so many providers who just bill for writing a report because it is, you know, it is required, but they never actually discussed it with the participant.

Will, EnableUs Community

This is the consent trap, and it is a ticking compliance bomb. Under the NDIS Terms of Business, you cannot charge for non-face-to-face support unless you have discussed the specific task with the participant, explained why it is essential, and gotten their prior consent. And that consent has to be written into a signed service agreement. If your agreement only lists direct support hours, and you bill for non-face-to-face time, you are in breach. It is that simple.

Winter, EnableUs Community

Wow. So even if the work is totally legitimate, like spending thirty minutes writing a complex clinical transition report, if it is not explicitly pre-authorized in that signed service agreement, the NDIA can just take that money back. That is a massive administrative headache to go back and fix all those agreements, but I guess it is better than the alternative.

Will, EnableUs Community

Absolutely. And then you have to back it up with contemporaneous records. That means you write the progress note right when you finish the work, not a week later when you are trying to remember what you did. It has to show the exact date, the duration, the specific NDIS goal it links to, and the precise outcome. No more writing administrative tasks or session preparation. It needs to say, spent thirty minutes writing assessment summary for upcoming planning meeting, linked to goal two. That is how you survive an audit.

Winter, EnableUs Community

Well, that is a very clear line in the sand. Update those service agreements, use the new underscore NF suffix, and write highly specific progress notes. Thanks for walking us through the maze, Will. Talk next time.

Will, EnableUs Community

No worries, Winter. Talk soon.