Provider Guide · Updated 18 May 2026
A plain-language guide to the NDIS Pricing Arrangements and Price Limits — support categories, allied health item numbers, travel and cancellation rules, and the three plan management types. Built for allied health practitioners, support coordinators, and behaviour support providers running their own practice.
Section 1 — Plan Structure
Every NDIS plan is divided into three top-level budget categories. The most common provider mistake is assuming funds can be moved between them — Capacity Building funding cannot be spent on Core supports, and vice versa.
| Category | Flexibility | What it funds |
|---|---|---|
| Core Supports | Flexible across budget | Everyday assistance with daily life — personal care, household tasks, community participation, consumables (continence aids, low-cost AT). |
| Capacity Building | NOT flexible — locked to subcategory | Builds skills and independence over time. Funding is allocated to specific outcome areas and cannot be moved between them. |
| Capital Supports | Separate quotes required | One-off purchases of higher-cost assistive technology, home and vehicle modifications. Each item is individually quoted and approved. |
Section 2 — Item Numbers
Each allied health discipline has its own NDIS item number that must appear on every invoice and claim. The codes below are the standard Improved Daily Living (Capacity Building 15_) items. Hourly price caps shown are for standard regions — remote and very remote attract uplifts.
15_055_0128_1_3
Price cap (standard region): $193.99/hr
15_054_0128_1_3
Price cap (standard region): $166.99/hr
15_053_0128_1_3
Price cap (standard region): $193.99/hr
15_056_0128_1_3
Price cap (standard region): $222.99/hr
15_044_0128_1_3
Price cap (standard region): $156.16/hr
15_621_0128_1_3
Price cap (standard region): $193.99/hr
15_058_0128_1_3
Price cap (standard region): $193.99/hr
15_517_0118_1_3
Price cap (standard region): $234.83/hr
Standard caps apply in MMM 1–5 regions. Remote (MMM 6) supports attract a +40% uplift and very remote (MMM 7) supports attract a +50% uplift on the published price limit. The Modified Monash Model classification of the participant's usual residence determines which cap applies.
Item codes and price caps reflect the NDIS Pricing Arrangements and Price Limits document. Always confirm the current version at ndis.gov.au.
Section 3 — Travel Claiming
Travel is one of the most commonly under-claimed and over-claimed line items on NDIS invoices. There are two distinct travel types, each with its own cap.
Travelling from your office (or previous appointment) to the participant's location. Claimable up to the maximum time per leg based on geographic band.
When you see multiple participants back-to-back, the travel time between them is claimable. Same per-leg time caps apply, and the cost is split proportionally between the participants receiving the supports.
Travel time is claimed at the same hourly rate as the support being delivered (e.g. physiotherapy travel = physio hourly cap). This is distinct from non-labour vehicle costs — fuel, depreciation, wear — which are claimed at the NDIS-published per-kilometre rate (claimed under non-labour transport, not as time).
Section 4 — Cancellation Policy
The NDIS allows providers to claim a cancellation fee when a participant cancels with insufficient notice — but the rules are prescriptive, and a sloppy cancellation claim is the fastest way to fail an audit.
When a participant cancels (or fails to show up) inside the 7-clear-day window, you can claim the full session fee against their plan budget. “Clear days” means the session day and the cancellation day are both excluded from the count.
Before claiming the cancellation fee, document that you offered the participant a make-good appointment and they declined or didn't respond. This evidences the “reasonable steps” expectation in the Pricing Arrangements.
Cancellation invoices need to reconcile back to a service agreement that the participant signed and that included a cancellation clause aligned with NDIS rules. No clause = no claim, even if you followed every other step correctly.
Section 5 — Plan Management
The plan management type controls who you invoice, how fast you get paid, and whether you need to be NDIS-registered. Most practices accept a mix of all three.
NDIS pays providers directly through the participant portal.
Only NDIS-registered providers can deliver these supports. Providers claim through the myplace provider portal at the published price limit or below. Faster payment but you must be registered, audited, and meet the NDIS Practice Standards.
A registered plan manager pays the invoice on the participant's behalf.
The plan manager is the registered provider — the actual support provider does not need to be NDIS-registered. You invoice the plan manager, who pays you and claims from NDIS. Most allied health practices service plan-managed clients this way without taking on full registration.
The participant pays you directly and claims reimbursement from NDIS themselves.
No registration requirement. The participant decides whether to pay your full fee (potentially above the price cap if they choose to top up) and submits the invoice to NDIS for reimbursement up to the published cap. You get paid like any private client — by EFT or card.
For NDIA-managed and plan-managed participants the cap is a hard ceiling — invoice above and the claim bounces. If your private-client rate exceeds the NDIS cap, you either absorb the gap on NDIS clients or carry a separate price book. Don't try to recover the difference through inflated travel or report-writing line items.
Participant NDIS number, plan management type, support item code, date(s) of service, hours, hourly rate, and total. Plan managers reject invoices that miss any of these fields, and NDIA processing slows down for the same reason. Build a template once.
The NDIS Quality and Safeguards Commission expects every invoice to map back to a service agreement, session notes, and consent. Records must be retained for 7 years. Software that stamps session start/finish and notes is the single highest-leverage investment for audit readiness.
Full NDIS provider registration requires audit against the Practice Standards and ongoing compliance costs. Many allied health practices operate viably on plan-managed and self-managed clients alone — registration only pays off when Agency-managed referrals are a meaningful share of your pipeline.
No — registration is only required if you accept NDIA-managed (Agency-managed) participants. Most allied health providers operate registration-free by working only with plan-managed and self-managed participants, which together make up the large majority of plans. You can choose to register later if you want to broaden your client pool.
The NDIS Pricing Arrangements and Price Limits are reviewed annually and the updated document takes effect on 1 July each financial year. Mid-year amendments occasionally happen for specific items. Always check ndis.gov.au for the current document before quoting or invoicing.
For Agency-managed and Plan-managed participants — no, the price limit is a hard cap. For self-managed participants you technically can, but NDIS will only reimburse them up to the cap and they pay the gap out of pocket. Best practice is to stay at or under the cap unless you have a clear written agreement about a top-up.
If a participant cancels within 7 clear days of the scheduled session (short notice) you can claim 100% of the session fee, provided you first attempted to offer an alternative time and the participant did not accept. The cancellation must be documented and the service agreement must include cancellation terms before the session was booked.
Non-labour costs are out-of-pocket expenses incurred while delivering a support — most commonly vehicle running costs when you drive to a client. These are claimed at the NDIS-published per-kilometre rate, separately from any travel time you also charge. Other non-labour costs include consumables used during a session and report-writing materials, where allowable under the relevant item number.
Short notice cancellation means the participant told you they couldn't attend within 7 clear days of the booking. A no-show means the participant didn't attend and didn't tell you. Both are claimable at 100% under the NDIS rules, but documentation differs — for a no-show you need to record your attempt to contact them and confirm they did not arrive within a reasonable window.
OneBookPlus tracks NDIS item numbers, plan management type, and service-agreement consent on every appointment — built for Australian allied health providers.
Last reviewed and updated: by Bishal Shrestha
About the author
Founder & CEO, OneBookPlus
Bishal has over a decade of experience in digital marketing, web development, and small business consulting across Australia. Bishal has supported NDIS-registered allied-health providers with price-guide item codes, travel claiming, and cancellation policy enforcement.
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