NDIS line items explained: How to choose the right code and avoid claim rejections

Managing National Disability Insurance Scheme (NDIS) invoices can be time consuming, and quick payment makes a big difference to your day‑to‑day work. The good news is there’s a simple way to speed things up and reduce the risk of having an invoice knocked back.

While it’s not mandatory, adding the correct line item number when you send an invoice to a plan manager or the National Disability Insurance Agency (NDIA) can help your claim move through more smoothly. On the other hand, using the wrong number, or not following Agency rules around line items, can lead to delays or rejections.

In this article, we break down how line items work, why claims get rejected, and the common slip ups that providers can easily avoid. If you want fewer admin headaches and faster payments, this guide will help.

What are NDIS item numbers and why do they matter?

NDIS item numbers are numerical codes that represent specific supports, services or products that are funded in a participant’s NDIS plan.

A line item contains not just the item number but also the item name and notes.
Choosing the right item number helps the NDIA process your claim faster.

Anatomy of a line item: How to read line items and item numbers

The National Disability Insurance Scheme (NDIS) Pricing Arrangements and Price Limits contains more than 800 line items for providers to claim from. And, given a line item lets the NDIA know which budget category in your client’s plan should pay for your services, they're one of the most valuable tools in a provider's toolkit.

A line item has two components: an item number and a description of the service provided (item name and notes). Below is an example from the NDIS Pricing Arrangements and Price Limits.

Each item number contains a support category, sequence number, registration group, outcome domain, and support purpose. When broken up, it looks like this:

How to locate the right item number for the NDIS

You can find NDIS line items online within the NDIS Pricing Arrangements and Price Limits document.

When you’re locating a line item in the NDIS Pricing Arrangements and Price Limits, it helps to understand ‘support purposes’ and ‘categories’.

NDIS funding is broken up into four support purposes or ‘budgets’ – Core Supports, Capital Supports, Capacity Building Supports and Recurring Supports. And within each budget, there are several categories.

Take a look at the budget and category breakdown below for NDIS plans on PACE:

To find the correct line item, open the NDIS Pricing Arrangements and Price Limits, find the correct budget (i.e. Core Supports, Capital Supports or Capacity Building Supports) and category, (i.e. 01 Assistance with Daily Life), then locate the line item that aligns to the service you’ve provided. You can identify this through the ‘Item Name and Notes’ seen in the example below:

One quick tip – use the find function by hitting control + f and search for a word that describes your service, such as ‘support’ or ‘physiotherapy’. This will help you find the right line quickly!

Four common reasons why an NDIS claim could be declined

The NDIA has rules and requirements around line items that, if not adhered to, could cause a claim to be declined.

At My Plan Manager, we see millions of invoices every year and can tell you from experience what the NDIA does and doesn’t accept.

To help you pre-empt and avoid roadblocks, we’ve outlined a few common causes of claim rejections.

1. A provider claims more than is allowed under the NDIS Pricing Arrangements and Price Limits for a specific line item

The NDIA requires providers to claim within the rates set out in the NDIS Pricing Arrangements and Price Limits. If a claim exceeds those rates, it indicates a provider is either using the wrong line item or charging above the approved rate. Below are two examples:

• A provider charges a client $240 for three hours of support delivered on a Sunday, using item number 01_011_0107_1_1. The claim fails because the provider used a weekday item number, which has a price limit of $70.23 per hour. Had the provider claimed using the 01_014_0107_1_1 item number for support work delivered on a Sunday, the claim would’ve succeeded.
• A provider charges a client $240 for three hours of support delivered on a Tuesday, using the 01_011_0107_1_1 item number. The claim fails because the price per hour exceeds the NDIA’s limit of $70.23.

Takeaway: Be sure your claim doesn’t exceed the NDIS Pricing Arrangements and Price Limits, and if it does, check it contains the right item number.

2. The item number doesn't exist

The NDIS Pricing Arrangements and Price Limits is continually changing and sometimes providers submit claims with item numbers that no longer exist.

For example, the Temporary Transformation Payment (TTP) for disability support worker-related supports ended on 30 June 2024, and providers can no longer claim the TTP loading. If providers claim under the old method after this time, their claim will be declined, and they’ll need to resubmit it using the current NDIS pricing arrangements.

Takeaway: Be sure the item number you’re claiming against is current.

3. When a support category or support purpose isn't included in a client's plan

For example, if you invoice for personal training when your client doesn’t have the Improved Health and Wellbeing category in their NDIS plan, the claim will be rejected.

As a provider, you’re reliant on your client to be transparent about their NDIS funding, so you know it’ll cover the supports you provide. That’s why it’s good to understand whether your supports are funded, and to put a service agreement in place. Both reduce the likelihood of a claim being denied.

Here are our tips for writing an A+ service agreement.

Takeaway: Before commencing supports, check with your client to make sure there's funding available in their plan for the budgets and categories related to your services – and make sure there’s enough funding left to cover your fees.

4. A practitioner provides therapies that the NDIA doesn’t recognise or a therapist doesn’t have the necessary qualifications

In the NDIS, therapeutic supports are delivered by a broad range of qualified professionals. They also account for one of the largest groups of funded supports in the Scheme.

Many therapeutic supports are delivered by allied health professionals (e.g., an occupational therapist) – university qualified professionals with specialised expertise in developing and implementing strategies to help build a participant’s capacity for independence.

Therapeutic supports can be delivered by a range of professionals, if their qualifications align with the NDIS Pricing Arrangements and Price Limits. For example, a qualified music therapist who’s registered with the Australian Music Therapy Association can deliver therapeutic supports to NDIS participants.

Takeaway: If you’re providing therapeutic supports to an NDIS participant and charging as an allied health professional, you’re required to have the correct credentials to provide the therapies the NDIA recognises. Generally, alternative therapies aren’t funded under an NDIS plan, and established therapies are much more likely to be funded. You can have a look through the list of what are, and what are not, considered NDIS supports here: Supports funded by the NDIS.

A little bit more about claiming rules

The NDIA has other claiming rules, aside from allocating correct item numbers, that providers are expected to adhere to as well. Here’s just a few:

• There are certain supports you can and can’t charge travel for and it’s the same for activity-based transport. You can find these rules in the NDIS Pricing Arrangements and Price Limits, under ‘Provider Travel’ and ‘Claiming under activity based transport’. Providers can only claim for travel costs related to the delivery of a support item if specific conditions are met.
• Assistive technology over $1500 must be come out of a participant's Assistive Technology budget.
• Different item numbers and price limits may apply, depending on the time of day and the day of the week supports are delivered on. Some supports must be delivered face-to-face and invoices require an item number to reflect that. Be sure to check the category you’re claiming under before invoicing.

How My Plan Manager can help

If you need help or a second opinion about line items or claims, we’re here to help. You can email us at enquiries@myplanmanager.com.au or call us on 1800 958 018 from 8am-5.30pm (SA time), Monday to Friday.