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Does your therapy caseload still pay at the 2026–27 price limits? A clinician-by-clinician check

Since 1 July 2026, each therapy discipline claims through six line items, and travel earns half the direct rate. This check works out what one clinician's funded caseload brings in, what it costs, and the billable hours a week it needs. A fictional worked example runs every step.

Updated · 9-minute read

Occupational therapy and speech pathology price limits didn't move this year. Psychology rose. Dietetics, exercise physiology and Other Professional fell. But the hourly limit is only part of the answer. What a clinician's week earns depends on how much of it is claimable, and on which line.

This guide works through one clinician at a time. You need their pay and on-costs, a typical week's sessions, and your practice overheads. Any spreadsheet will do. All amounts are in Australian dollars, at national price limits; remote and very remote limits are 40% and 50% higher.

What changed on 1 July 2026

Every therapy discipline now claims through six line items. Before 1 July, the same work went on one item, with a claim type chosen in the portal. For occupational therapy (item 15_617_0128_1_3), at national prices:

Line item Suffix Price limit per hour
Direct service none $193.99
Telehealth _TH $193.99
Non-face-to-face _NF $193.99
NDIA requested reports _RR $193.99
Cancellation _CA $193.99
Provider travel _PT $97.00

Five lines pay the direct rate. Provider travel pays half. Travel at half the limit started on 1 July 2025; what's new is its own line.

The NDIA's Pricing Schedule 2026–27 applied as guidance from 1 July. Since 24 September 2026, the Minister's first pricing determination has set the same prices as maximum amounts.

Discipline (national, per hour) 2025–26 2026–27 Travel, 2026–27
Psychology $232.99 $252.99 $126.50
Occupational therapy $193.99 $193.99 $97.00
Speech pathology $193.99 $193.99 $97.00
Podiatry $188.99 $188.99 $94.50
Physiotherapy $183.99 $183.99 $92.00
Dietetics $188.99 $178.99 $89.50
Exercise physiology $166.99 $161.99 $81.00
Other Professional (outside early childhood) $193.99 $156.16 $78.08

Price limits apply only when a participant's funding is agency-managed or plan-managed, and they already include any GST. They're maximums, not set fees.

The rules that decide what an hour earns

The NDIA says it will publish 2026–27 claiming guidance shortly. Until then, the guidance it still hosts is the Pricing Arrangements and Price Limits 2025–26. These rules matter most for this check. Read them on ndis.gov.au before you rely on them.

  • Travel time. Claimable up to 30 minutes each way in MMM 1–3 areas and 60 minutes in MMM 4–5, with no time cap in MMM 6–7. Return travel after the last participant counts only if you must pay the worker for it, or you're a sole trader going back to your usual place of work. Time over the cap is yours to absorb. Vehicle costs are a separate item, up to $0.99 a kilometre, if the participant agrees.
  • Short-notice cancellations. Less than 2 clear business days' notice, or a no-show. You can claim up to 100% of the agreed fee if the service agreement allows it, you couldn't find other billable work for that clinician, and, for an employer, you still pay them for the time.
  • Non-face-to-face time. Only work that's part of delivering that participant's support, agreed in advance. Training, supervision and admin such as bookings, service agreements, plan monitoring and claims are covered by the price limit and aren't billable.
  • NDIA requested reports. Only reports the NDIA asks for: at the start of a plan, at a plan review, or where the plan says one is needed. Agreed in advance.
  • Part hours. Claim the time spent. Ten minutes of non-face-to-face work at $193.99 an hour is $32.33.

Every rule has conditions. This check doesn't decide what you can claim. It adds up what your own claims and times produce.

The check, one clinician at a time

Step 1: Cost per working week

Add the clinician's salary, super at 12% and other on-costs, such as workers' compensation, registration, indemnity cover and training. Divide by their working weeks: 52, less annual leave, public holidays, personal leave and training days. Leave is paid but not billable, so this loads it into every week they work.

Then work out their share of practice overheads: rent, software, insurance, reception and other running costs, split across clinicians by paid hours. For an owner, use the pay you want to draw. For a contractor on a share of fees, the cost moves with revenue, so the practice's share of fees is the contribution.

Step 2: A typical week, by session type

List a typical working week: clinic sessions, home or school visits, telehealth, report hours and cancellations you charge. For each session type, note the direct minutes, travel minutes each way, the claimable travel after the cap, non-face-to-face minutes you claim, and admin minutes you don't.

Step 3: Revenue by line item

Multiply the hours claimed on each line by the rate in the service agreement, which can't exceed the price limit for agency-managed and plan-managed participants.

Step 4: Contribution per paid hour

Contribution          = weekly revenue - cost per working week
Contribution per hour = contribution / paid hours in the week
Utilisation           = billable hours / paid hours

Step 5: Break-even billable hours

Average revenue per billable hour = weekly revenue / billable hours
Break-even billable hours         = (cost per working week + overhead share)
                                    / average revenue per billable hour

A billable hour here is any hour claimed on any line. Travel hours earn half, so a caseload with more travel has a lower average and needs more billable hours to break even.

Step 6: Stress test

Change one thing at a time: fewer hours bought, more cancellations, longer travel. Budgets for Improved Daily Living Skills supports, the support category the therapy items numbered 15_ sit in, are reduced by 10% as plans are created, reassessed or renewed between 1 October 2026 and 30 September 2027. Some supports are exempt. If participants buy fewer hours, billable hours fall. Paid hours don't.

A worked example (fictional)

Fictional example. Saltbush Lane Therapy is not a real practice. The figures are illustrative and are not a customer result.

One occupational therapist works full time, 38 paid hours a week, in a metropolitan (MMM 1) area.

  • Cost: salary $98,000, super at 12% $11,760, other on-costs at 7% $6,860. Total $116,620 a year.
  • Working weeks: 44, after 4 weeks of annual leave, 2 of public holidays, 1 of personal leave and 1 of training. Cost per working week: $116,620 ÷ 44 = $2,650.45.
  • Overhead share: $180,000 a year across four full-time clinicians is $45,000 each, or $1,022.73 a working week.

A typical week:

  • 10 clinic bookings: 9 delivered, and 1 cancelled with a day's notice and charged in full. The service agreement allows it, and the slot couldn't be filled.
  • 6 home visits, each a round trip of 40 minutes each way from the clinic. 30 minutes each way is claimable; 20 minutes a visit is absorbed.
  • Every delivered session: 10 minutes of non-face-to-face work claimed, and 10 minutes of admin not claimed.
  • 1 hour of NDIA requested report writing.
  • 2 hours of supervision and team meetings, not billable.
Line Hours claimed Revenue
Direct service, clinic 9.0 $1,745.91
Direct service, home visits 6.0 $1,163.94
Non-face-to-face (15 × $32.33) 2.5 $484.95
Provider travel (6 × 60 minutes) 6.0 $582.00
NDIA requested reports 1.0 $193.99
Cancellation 1.0 $193.99
Total 25.5 $4,364.78

The results:

  • Contribution: $4,364.78 − $2,650.45 = $1,714.33 a working week, or $45.11 per paid hour.
  • Utilisation: 25.5 ÷ 38 = 67%.
  • Average revenue per billable hour: $4,364.78 ÷ 25.5 = $171.17.
  • Break-even for the clinician alone: $2,650.45 ÷ $171.17 = 15.5 billable hours a week.
  • Break-even with the overhead share: ($2,650.45 + $1,022.73) ÷ $171.17 = $3,673.18 ÷ $171.17 = 21.5 billable hours a week.
  • After the overhead share: $691.60 a week, about $30,430 over 44 weeks, or 15.8% of revenue.

The other 12.5 paid hours go on 2.5 hours of unclaimed admin, 2 hours of travel over the cap, 2 hours of supervision, and 6 hours of gaps between bookings, extra notes and other unbilled work.

Two things stand out. The first is session type. A clinic session earns $226.32 for 80 minutes of the clinician's time: $169.74 per hour worked. A home visit earns $323.32 for 160 minutes: $121.25 per hour worked.

The second is headroom. The clinician bills 25.5 hours against a break-even of 21.5, so the margin for error is 4 hours a week. If every participant buys 10% fewer hours, billable hours fall to 22.95 and revenue to $3,928.30. The week still covers the overhead share, with $255.12 left, but headroom shrinks to 1.5 hours. Two more clinic sessions a week lost to cancellations that can't be charged would then take it below break-even.

The NDIA's guidance asks providers to keep participants' travel costs low, for example by grouping appointments in an area or using telehealth where it suits. Both also cut the travel time a practice absorbs.

What this check doesn't do

  • It doesn't decide what you can claim or charge. Check each claim against the NDIA's current rules and your service agreements.
  • It runs on a typical week. Each quarter, compare it with real weeks from your practice software and adjust.
  • It leaves out kilometre costs and recovery, non-NDIS work and self-managed fees unless you add them.
  • An overhead share is an allocation. Most overheads stay if one clinician leaves.

A planner for this, in research

We're researching a workbook that would run this check for every clinician and caseload pattern in a practice, in Excel and Google Sheets, with the 2025–26 and 2026–27 price limits side by side. It isn't built, and there's no price or date. If you'd like one email when it's ready, or one saying we've decided not to build it, join the waitlist.

Independence

Metricvalley is independent. This guide is not affiliated with or endorsed by the NDIA, the NDIS Quality and Safeguards Commission or the Australian Government. "NDIS" appears here only to say who the guide is for. Check ndis.gov.au for current prices and claiming rules. Nothing in this guide is financial, legal, tax or NDIS-compliance advice.

Sources

All accessed 1 October 2026.

Common questions

How much can a therapist claim for travel in 2026–27?

Provider travel has its own line item at half the direct price limit: $97.00 an hour for occupational therapy against $193.99. The NDIA's current guidance caps claimable travel time at 30 minutes each way in MMM 1–3 areas and 60 minutes in MMM 4–5, with no time cap in MMM 6–7. The NDIA says updated 2026–27 claiming guidance is coming, so check ndis.gov.au before you rely on the caps.

How do I work out break-even billable hours for one clinician?

Divide the clinician's cost per working week (salary, super and on-costs over the weeks they actually work), plus their share of overheads, by the average revenue per billable hour across every line you claim. In the worked example, $3,673.18 ÷ $171.17 = 21.5 billable hours a week.

Can I claim cancellations, reports and non-face-to-face time?

Only under the NDIA's conditions. In its current guidance, each must be agreed in advance in the service agreement. Cancellations need less than 2 clear business days' notice or a no-show, and no other billable work for that clinician. Reports must be requested by the NDIA. Non-face-to-face time must be part of delivering that participant's support, not admin. This guide doesn't decide what you can claim.

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