📋 Sources: NDIS Act 2013 — ndis.gov.au ↗. NDIS Pricing Arrangements and Price Limits 2025–26. NDIS guidance for health professionals — ndis.gov.au/health-professionals ↗. MBS Book July 2026. NDIS Quality and Safeguards Commission — ndiscommission.gov.au ↗. NDIS rules and pricing change annually. Verify current requirements at ndis.gov.au. Apply clinical and professional judgement. Consult your MDO for specific medico-legal questions.
Supporting evidence letters, functional impact reports, the nexus question, MBS billing for NDIS-related work, and common pitfalls.
MBS July 2026CliniciansAUNDIS Act 2013 · ndis.gov.au
📋 GPs are often asked to support NDIS access and plan reviews with letters and reports. This is legitimate, billable work — but the NDIS has specific requirements for what evidence is useful, and there are boundaries GPs should not cross.
The nexus question — NDIS vs Medicare
Every service involving a patient with a disability requires a decision: is this a health need (Medicare) or a disability-related support need (NDIS)? This is the “nexus question.” NDIS Act 2013 s.34
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Medicare: Treating, diagnosing, or managing a health condition. GP consult, pathology, specialist referral, care plan for chronic disease management.
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NDIS: Disability-related supports that build independence and daily functioning — not medical treatment. Support workers, therapy toward disability goals, assistive technology, home modifications.
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Not both: The same session or service cannot be claimed to both. Document the purpose clearly in your notes.
⚠️ Common audit risk: Allied health services (physio, OT, speech, psychology) billed via Medicare (GPCCMP item 10997) while the same patient’s NDIS plan also funds those services for disability goals. The services are legal if the purpose differs — but document the purpose clearly for each. NDIS Quality and Safeguards Commission
What GPs are asked to write — and what’s actually useful
For patients applying for NDIS access for the first time. ndis.gov.au
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What the NDIS needs: Evidence that the person has a permanent or likely permanent disability that substantially affects their daily functioning. Diagnosis alone is not enough — functional impact is what matters.
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What to include: Confirmed diagnosis with ICD-10 code; how long the condition has been present; whether it is permanent/likely permanent; how it affects daily activities (self-care, communication, mobility, learning, social participation); current supports already in place.
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What NOT to write: Do not recommend specific NDIS supports or funding amounts — that is the NDIS planner’s role, not the GP’s. Do not comment on whether the person “qualifies” for NDIS — that is an NDIS decision. State facts; let the NDIS decide. ndis.gov.au guidance for health professionals
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NDIS form: The NDIS has an Evidence of Psychosocial Disability form and a Supporting Evidence form. Ask the patient to bring the relevant form to the consultation. Available at ndis.gov.au ↗
For patients requesting a change in supports or plan review. ndis.gov.au
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Focus on functional change: What has changed in the person’s condition or circumstances that warrants a review? Document change in functional capacity, new diagnosis, or changed support needs. Avoid simply restating the original condition.
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Specific support requested: If the patient needs a particular type of support added, describe why it is needed and what the expected functional outcome is. Be concrete.
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Scope: GPs provide medical evidence. NDIS planners make funding decisions. Don’t commit to recommending specific dollar amounts or hours of support — this is outside your role and creates liability.
A structured report assessing functional capacity across daily living domains. ndis.gov.au
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Six functional domains (NDIS framework): Communication, social interaction, learning, mobility, self-care, and self-management. Rate impact in each domain. NDIS functional capacity framework ↗
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Be specific and observable: “Patient requires assistance with bathing and dressing daily due to upper limb weakness” is useful. “Has significant disability” is not.
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MBS billing: A detailed functional report (30+ minutes preparation) can be billed as item 36 or 44 based on time. It is GP work — bill appropriately. Do not complete these for free under time pressure.
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Scope: GPs provide medical and functional information. OTs are typically better placed for detailed functional capacity assessments — if the request is for a formal FCE, consider referring to OT (via GPCCMP if applicable). NDIS guidance
A shorter letter for general NDIS support — not a full functional report.
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Structure: Date, patient name/DOB, diagnosis with duration, brief description of functional impact in plain language, statement that the condition is permanent or likely permanent, your contact details and provider number.
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Language: Write for an NDIS planner, not another doctor. Avoid medical jargon. “This person has moderate to severe autism spectrum disorder (ASD, diagnosed 2018) that significantly affects his ability to communicate in unfamiliar environments, manage changes in routine, and engage in community activities independently.”
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MBS billing: Supporting letters are legitimate medical work. Bill via item 23 or 36 depending on time. A letter prepared outside a consultation can be billed as a non-attendance item.
Item 965 ($160.60) — GPCCMP for any chronic health conditions the patient has (e.g. epilepsy, cerebral palsy, ASD with comorbidities). NDIS and GPCCMP serve different purposes and can both be active.
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Item 2713 (CEASED Nov 2025) — use items 23/36/44 for NDIS case coordination work, not 2713.
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Important: NDIS does NOT fund GP consultations. Do not bill NDIS for GP consultations — these must be billed via Medicare. NDIS does not pay GP fees. NDIS Act 2013 s.34
Common pitfalls to avoid
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Don’t recommend specific supports or dollar amounts. “This patient needs 10 hours of support worker per week” is outside GP scope and may be challenged. State the functional need; let the NDIS plan for the support.
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Don’t write letters without adequate consultation time. NDIS evidence letters take time to do properly. Book a dedicated consultation rather than adding to an already complex visit.
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Don’t confuse diagnosis with disability. A diagnosis of ASD or ADHD does not automatically mean NDIS eligibility. What matters is the functional impact. A child with mild, well-managed ADHD may not meet NDIS criteria. Document functional impact, not just diagnosis.
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Don’t do detailed FCEs without specialist input. Formal functional capacity evaluations are OT territory for complex cases. GPs provide medical evidence and high-level functional observations — not a full FCE.
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Don’t double-claim. If an allied health service is being funded by NDIS for disability goals, do not also claim it via Medicare item 10997 (GPCCMP allied health) for the same session. Document purpose clearly to differentiate. NDIS Quality and Safeguards Commission