NDIS pricing is one of the most misunderstood areas of compliance for registered providers. The rules are detailed, they change annually, and getting them wrong can expose you to significant financial and regulatory risk, including demands to repay overpayments, compliance investigations, and in serious cases, registration consequences.
This guide gives you a clear breakdown of how NDIS pricing works, what you’re entitled to charge, and the billing mistakes the NDIS Commission and NDIA see most often.
How NDIS Pricing Works
The NDIS operates under a price-regulated model for registered providers. This means the NDIA sets maximum prices: called price limits, for most support categories. You cannot charge above these limits for registered participants claiming from their NDIS plan.
The rules are documented in the NDIS Pricing Arrangements and Price Limits (formerly the NDIS Price Guide), which is updated annually (and sometimes more frequently when the NDIA makes interim adjustments). For 2026, providers should ensure they’re working from the most current version published on the NDIS website.
A critical point: you cannot charge participants more than the published price limit for any support line. Doing so constitutes overcharging, which can constitute fraud against the scheme.
Registered vs Unregistered Providers: Different Rules
Before diving into what you can charge, it’s important to note that pricing rules differ based on whether you’re a registered or unregistered provider, and how your participant’s plan is managed.
Registered providers must comply with NDIS Pricing Arrangements for all participants claiming from NDIS-managed or plan-managed funding.
Unregistered providers are not bound by price limits when working with self-managed participants, those participants have more flexibility about who they use and what they pay. However, unregistered providers still cannot claim directly against NDIA-managed funds.
This guide focuses on registered providers, as they have the most compliance exposure around pricing.
Understanding Support Categories and Line Items
The NDIS Pricing Arrangements are structured around support categories (broad groupings) and support items (specific line items within each category). Each support item has a unique item number, a description, and a maximum price per unit.
Key support categories include:
– 01 – Daily Activities (assistance with daily life)
– 04 – Assistance with Social, Economic and Community Participation
– 07 – Support Coordination
– 08 – Improved Living Arrangements
– 09 – Increased Social and Community Participation
– 15 – Daily Activities (High Intensity)
Each category has its own price limits, and some items are further differentiated by:
– Time of day (standard, evening, night, or overnight)
– Day of week (weekday, Saturday, Sunday, public holiday)
– Support intensity (standard vs high intensity)
Billing the wrong time-of-day rate, or claiming a high-intensity rate for standard support, are among the most common billing errors.
What You Can Charge: Key Rules
1. You Can Only Charge for Supports Actually Delivered
This sounds obvious, but it’s where many providers run into trouble. You cannot pre-bill for supports not yet delivered. You cannot bill for a session that was cancelled (subject to specific rules, see below). You must be able to demonstrate that the support line you’re claiming for was actually delivered as described.
2. Time-of-Day and Day-of-Week Rates Apply
The NDIS has different price limits for:
– Weekday daytime (the standard rate, applies to supports delivered Monday–Friday during normal hours)
– Weekday evening (Monday–Friday after approximately 8pm)
– Saturday
– Sunday
– Public holidays
If you’re delivering support on a Sunday, you claim the Sunday rate. If the support spans from a Saturday evening into Sunday morning, you may need to split the claim. Claiming the weekday rate for a weekend delivery is undercharging (and likely incorrect for your workers too); claiming the Sunday rate for a weekday support is overcharging.
3. Travel Can Be Claimed: Within Limits
Providers can claim travel time and costs associated with delivering supports, but there are strict rules about how this works:
Worker travel time: You can claim the time a worker spends travelling to a participant’s location, up to the maximum rate for the relevant support type. You cannot claim travel time at a higher rate than the support being delivered. Travel cannot be claimed for the worker’s commute from home to their first appointment.
Non-labour travel costs: Reasonable vehicle running costs (per the ATO rate) can be claimed for travel directly related to support delivery. Tolls and parking can be claimed where reasonable.
Geographic loading: Providers in some remote and very remote areas may be eligible for a higher price limit due to the additional cost of service delivery in those locations.
4. Cancellation Fees Are Permitted: Under Specific Conditions
Short-notice cancellations are a significant issue for many providers, and the NDIS does allow providers to charge a cancellation fee, but only if all of the following conditions are met:
– The cancellation occurred within a specified short notice period (currently less than 2 clear business days for most supports)
– You had a worker rostered and ready to deliver the support who cannot be otherwise deployed
– Your service agreement with the participant includes a cancellation policy consistent with NDIS rules
– You have not already been paid for the same session through another source
The cancellation rate is capped at a percentage of the support price (currently 100% for most supports, with some exceptions). Importantly, you cannot claim a cancellation fee if the participant gave adequate notice, if you were not actually rostered to deliver, or if the participant had a legitimate reason (e.g., a medical emergency) unless your service agreement accounts for this.
5. Non-Face-to-Face Support Can Be Claimed in Some Circumstances
Some support items allow providers to claim for time spent on non-face-to-face activities related to a participant’s support, for example, coordination activities, report writing, or case conferencing. However:
– This is only permitted where specifically allowed under the support item description
– It cannot be claimed for general administrative tasks or business overhead
– It must be documented and directly linked to the individual participant
6. Claiming Telehealth / Remote Supports
Since the NDIS integrated remote support delivery into standard arrangements, providers can claim for supports delivered via phone or video. The same price limits apply. You still need to document the session, who participated, what was delivered, and the duration.
What You Cannot Charge
These are hard prohibitions under the NDIS Pricing Arrangements:
- Above the price limit for any support item: no exceptions for registered providers serving plan-managed or NDIA-managed participants
- For supports not delivered: including billing for a full hour when only 45 minutes were delivered
- General administrative overhead: the price you charge includes a contribution to your general admin costs; you cannot add on separate admin charges
- Registration or membership fees: you cannot charge participants a fee to access your services or to be on your books
- Cancellations outside the rules: charging cancellation fees when the conditions above aren’t met
- Duplicate billing: claiming for the same support from multiple funding sources (e.g., NDIS and a state government program) for the same session
- Supports outside your registration: you cannot deliver (or bill for) supports under registration groups you are not registered for
Where Providers Commonly Go Wrong
Claiming the Wrong Support Item
The NDIS has thousands of individual support items. Using the wrong item number, even if you deliver the right support, can result in an overpayment that the NDIA will seek to recover. Common errors include:
– Claiming a high-intensity item for standard support delivery
– Using a support coordination item for support that should be under assistance with daily life
– Applying a group support rate to 1:1 support or vice versa
Not Updating to the Current Price Limits
The NDIS Pricing Arrangements are updated at least annually. Providers who haven’t updated their invoicing systems to reflect the current year’s price limits may be over or under claiming. Under-claiming is your problem; over-claiming is a compliance issue.
Claiming Travel Beyond What’s Permitted
Over-claiming travel is one of the most common areas identified in NDIA compliance reviews. Providers sometimes claim travel for the worker’s commute, claim travel between consecutive supports that doesn’t qualify, or apply the wrong vehicle rate.
Incorrect Cancellation Billing
Charging a cancellation fee without a compliant service agreement, or without meeting the conditions for short-notice cancellation, is a frequent source of participant complaints and compliance referrals.
No Supporting Documentation
The NDIA can audit any payment claim. If you cannot produce documentation demonstrating that the support was delivered as claimed, progress notes, sign-in records, communication logs. The payment will be treated as incorrectly claimed and you’ll be required to repay it.
What Happens When You Overcharge?
If the NDIA or the Commission identifies that you’ve overcharged a participant, whether accidentally or deliberately, you’ll be required to repay the overcharged amount. The NDIA has the power to:
- Suspend payment processing while a review is underway
- Demand repayment of overpaid amounts
- Refer the matter to the Commission for compliance action
- Refer serious cases of fraudulent billing to the Australian Federal Police
Accidental errors are generally treated differently from patterns of overcharging, but even honest mistakes can become a compliance issue if they’re systemic or if you fail to self-correct once you’re aware of them.
If you identify a billing error, the best approach is to self-report, repay, and document the corrective action you’ve taken. Proactive disclosure is viewed far more favourably than errors discovered through external audit.
Practical Steps to Stay Compliant
Download and implement the current NDIS Pricing Arrangements at the start of each financial year. Update your invoicing system to reflect the latest price limits.
Review your support items annually: make sure you’re using the correct item numbers for every support type you deliver.
Ensure your service agreements include a compliant cancellation policy: and that your billing team only charges cancellations when all conditions are met.
Document every support session: duration, what was delivered, who was present, any relevant observations. This is your evidence if a payment claim is ever challenged.
Audit a random sample of your claims quarterly: cross-reference invoiced amounts against delivered supports and check item numbers against the Pricing Arrangements.
Train your admin and billing team: they need to understand the rules as well as your clinical or support staff do.
Final Thought
NDIS pricing compliance isn’t just a finance team problem, it’s a whole-of-organisation responsibility. The providers who stay out of trouble are the ones who treat billing accuracy with the same rigour they apply to support delivery: systems, training, documentation, and regular review.
If you’re not confident your billing practices are fully compliant, a proactive review now is far less costly than a compliance investigation later.
Need help reviewing your billing and compliance systems? Talk to the HPA team, we work with registered providers to build compliant, audit-ready operations from the ground up.
