Last updated: April 18, 2026 · Draft pending legal review
These Terms of Service ("Terms") govern your use of CareCost Estimate, an informational decision-support tool for healthcare providers ("the Service"). By creating an account, clicking "I acknowledge" on a disclosure dialog, or otherwise using the Service, you agree to these Terms.
CareCost Estimate is an informational reference for healthcare providers. The Service provides tools to:
The Service is intended solely to display existing medical information, publicly-reported pricing data, and recommendations that a qualified healthcare professional can independently review before acting. It is not intended to replace clinical or billing judgment.
The Service does not provide medical, reimbursement, coding, billing, or legal advice. All outputs are estimates based on data available at the time of the query, including CMS-published ASP pricing, the CMS NDC-HCPCS crosswalk, openFDA drug listing data, payer-published fee schedules, Medicare Advantage and commercial contract data where made available, and manufacturer- or foundation-published patient assistance program terms.
Estimates are not a guarantee, promise, or statement of:
The Service does not include all possible or required billing and coding options for any drug listed. Actual patient costs and provider reimbursement may differ substantially due to payer-specific contracts, formulary and coverage decisions, claim adjudication variations, coordination of benefits, retroactive benefit changes, patient eligibility changes, and other factors outside of the Service's knowledge.
It is the sole responsibility of the healthcare provider to refer to, verify, and comply with payer-specific policies regarding coding, coverage, prior authorization, and billing before submitting any claim or counseling any patient on expected out-of-pocket cost.
The Service is designed to meet the criteria of a non-device clinical decision support ("CDS") software function under Section 520(o)(1)(E) of the Federal Food, Drug, and Cosmetic Act, as amended by the 21st Century Cures Act. Specifically, the Service:
Our Methodology and Data Sources page describes, in plain language, the inputs, data sources, calculation logic, update cadence, and known limitations of the Service. Users are expected to consult the Methodology page before relying on any output.
Pricing estimates in this Service are derived, in part, from public CMS data including the Medicare Part B Average Sales Price (ASP) Pricing Files and the NDC-HCPCS Crosswalk, updated quarterly. The absence or presence of a HCPCS code, NDC, or payment limit in CMS data does not indicate whether Medicare or any other payer covers a particular product, and products not listed may still be reimbursable under applicable payer policy. CMS disclaims responsibility for any liability attributable to end-user use of this data and is not a party to these Terms.
You agree not to:
Our handling of your data is governed by our Privacy Policy. Key points:
TO THE MAXIMUM EXTENT PERMITTED BY LAW, THE SERVICE IS PROVIDED "AS IS" AND "AS AVAILABLE," WITH ALL FAULTS AND WITHOUT WARRANTY OF ANY KIND, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHERWISE. CARECOST EXPRESSLY DISCLAIMS ALL WARRANTIES, INCLUDING THE IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, QUIET ENJOYMENT, ACCURACY, AND NON-INFRINGEMENT.
CARECOST MAKES NO WARRANTY THAT THE SERVICE WILL BE UNINTERRUPTED, ERROR-FREE, COMPLETE, CURRENT, OR FREE OF HARMFUL COMPONENTS, OR THAT ANY OUTPUT OF THE SERVICE WILL BE ACCURATE OR RELIABLE.
TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT SHALL CARECOST, ITS AFFILIATES, OFFICERS, EMPLOYEES, OR LICENSORS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO DAMAGES FOR LOST PROFITS, LOST REVENUE, LOST REIMBURSEMENT, DENIED CLAIMS, COVERAGE DETERMINATION ERRORS, OR COST-ESTIMATE DISCREPANCIES, WHETHER OR NOT CARECOST HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.
CARECOST'S TOTAL AGGREGATE LIABILITY ARISING OUT OF OR RELATING TO THESE TERMS OR THE SERVICE SHALL NOT EXCEED THE GREATER OF (A) THE AMOUNTS PAID BY YOU TO CARECOST UNDER THESE TERMS IN THE TWELVE (12) MONTHS IMMEDIATELY PRECEDING THE EVENT GIVING RISE TO LIABILITY, OR (B) ONE HUNDRED UNITED STATES DOLLARS (USD $100). [Cap amount pending legal review.]
You agree to defend, indemnify, and hold harmless CareCost, its affiliates, officers, directors, employees, agents, and licensors from and against any and all claims, liabilities, damages, losses, and expenses (including reasonable attorneys' fees) arising out of or in any way connected with: (a) your access to or use of the Service; (b) your submission of any claim, prior authorization, or patient communication based on Service output; (c) your violation of these Terms; (d) your violation of any third-party right, including any payer policy or federal or state law; or (e) any dispute between you and a patient, payer, or other third party.
We aim for high availability but do not guarantee uninterrupted service. Planned maintenance will be communicated in advance where practical. Enterprise customers receive priority support.
We may suspend or terminate your account if you violate these Terms or if required by applicable law. You may cancel your account at any time through Settings or by contacting us. Upon termination, your data will be retained for 30 days and then permanently deleted, except where retention is required by law or for tax, audit, or dispute-resolution purposes.
We may update these Terms from time to time. Material changes will be communicated via email and a re-acknowledgement dialog shown on next login. Continued use of the Service after changes take effect constitutes acceptance of the updated Terms.
[This section is pending legal review. Expected content: choice of law, exclusive venue, waiver of jury trial, and binding individual arbitration with class-action waiver, subject to applicable law. Users will be re-prompted to accept updated Terms when this section is finalized.]
These Terms, together with our Privacy Policy, HIPAA Compliance notice, and Methodology, constitute the entire agreement between you and CareCost regarding the Service and supersede all prior agreements. If any provision of these Terms is held unenforceable, the remaining provisions will remain in full force and effect.
For questions about these Terms, contact us at legal@carecostestimate.com.