US · guidance
CMS Pub. 100-16, ch. mc86c18a, § 50
Prudent Buyer Principle
The HCPP is expected to minimize costs incurred in furnishing physicians' and other Part
B supplier services to the HCPP'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. 30, 09-05-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
ba958ea80a2b70246b6f1720ad2d2b4aa057c0931f52c0b5077155d3a6faa807
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