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New Therapy Line Items

The price structure in the new price guide has had a bit of shake up, here's a break down of the changes.

By Dr Kylie Morgan

Updated 15 Apr 202426 Jul 2022

Some professionals delivering therapeutic supports have been surprised by the release of new support item codes in the most recent Pricing Arrangements and Price Limits. Previously, there were three types of codes for therapeutic supports: psychology, physiotherapy, and “other professional”, with other professional the catch-all for any type of therapeutic support other than psychology and physiotherapy. There were line items for each of these professions under Improved Daily Living and Core (for disability related health supports), with specific line items for delivering support for Early Childhood to those  under seven years of age.

The new Pricing Arrangement and Price Limits have shaken up the structure of these line items. Here’s what’s changed.

Disability Related Health Supports

When delivered to a child under the age of seven, there are five disability related health support line items to choose from, depending on the therapist’s profession: Counsellor, Exercise Physiologist, Physiotherapist, Psychologist, or Other Professional.

However, if the disability related health supports are being delivered to a person aged seven or older, then the options are Dietitian, Occupational Therapist, Physiotherapist, Podiatrist, Psychologist, Speech Pathologist, and Other Professional.

Improved Daily Living

Under Improved Daily Living, the choice of professions for early childhood is the same as under disability related health supports: Counsellor, Exercise Physiologist, Physiotherapist, Psychologist, and Other Professional.

For those aged seven or older, the list has been expanded and now has separate support items for Art Therapist, Audiologist, Counsellor, Developmental Educator, Dietitian, Exercise Physiologist, Music Therapist, Occupational Therapist, Orthoptist, Physiotherapist, Podiatrist, Psychologist, Rehabilitation Counsellor, Social Worker, Speech Pathologist, and Other Professional.

Impact on providers

Since the new support items were introduced, there has been some confusion as to who is responsible for ensuring that providers claiming under these support items have the required qualifications. This is an especially tricky situation for plan managers, who have historically received mixed messages from the NDIA about precisely which information they are responsible for verifying.

Assessing the qualifications of a provider to deliver support is typically the responsibility of the NDIS Commission, not the NDIA – certainly not plan managers. But in the absence of clear instructions from the NDIA and amid vague threats of being made to repay funds spent not in accordance with the plan, plan managers are coming down on different sides of the argument. Some therapy providers are reporting that their invoices are now being rejected or sent back with requests for evidence of their professional registration or revised invoices with the new codes.

So, whose responsibility is it? There are no easy answers here – for now. Let’s hope the NDIA provides clarity sooner rather than later.

Authors

Dr Kylie Morgan

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