US · guidance
CMS Pub. 100-16, ch. mc86c17a, § 60
Prudent Buyer Principle
The HMO/CMP is expected to minimize costs incurred in furnishing physicians' and
other Part B supplier services to the HMO/CMP's Medicare enrollees so that actual costs:
• Do not exceed what a prudent and cost conscious buyer would incur; and
• Are comparable to costs incurred for similar services furnished by similar
physicians or other suppliers in the same or similar geographic area
If costs are determined to exceed the level that such buyers incur, in the absence of clear
evidence that the higher costs were unavoidable, the excess costs are not paid under the
Medicare program.
History
(Rev. 4, 10-01-01)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
dc3e3f8e1deae84f6ddeab3127fb7c3aeb26528264a87d05c47ead20f28ac58a
The link goes to the issuing authority’s own document — the one we read to produce this record. Where a source publishes whole titles rather than sections, your browser may need a moment to jump to the provision.
Unofficial copy of government-published law, reproduced from official sources with full provenance. Not an official publication; verify against official sources before relying on it in a filing. Records in the 'guidance' corpus, and only that corpus, are sub-regulatory (interpretive guidelines, survey procedures) and are not binding law. Validity bounds follow each jurisdiction's declared temporalBasis.