Physician Practice · All 50 States
Your home care costs
may already be
tax-free.
A board-certified physician reviews your care plan and issues a Letter of Medical Necessity — making home care, companion care, and wellness costs reimbursable through your HSA or FSA. Most families never claim it.
$199 flat. Delivered in 48 hours. No charge if denied.
LMN may make care costs HSA-eligible. Eligibility depends on your plan.
Josh Emdur, DO — Medical Director
BCH hospitalist since 2008 · 50-state licensed · co-op.care co-founder
How LMNs work
Three steps from intake to signed letter.
Submit your intake
5 minutes online. Describe what you need—home care, wellness equipment, a care plan. No appointment required.
Josh reviews and signs
Sage AI prepares a draft based on your intake. Josh Emdur, DO personally reviews every case, edits as needed, and signs each letter himself. No batch processing. No unlicensed staff.
Letter delivered
Signed PDF to your inbox within 48 hours. Submit to your HSA/FSA administrator. Valid nationwide. No charge if the letter is denied.
Clinical services
Altru.care is Josh Emdur’s physician practice. co-op.care is the worker-owned care cooperative he supervises clinically. Both are real services; they are separate entities. Josh signs every LMN personally.
Primary service
Letter of Medical Necessity
Makes home care, wellness services, and medical equipment costs reimbursable through HSA or FSA. Physician-signed within 48 hours. $199 flat. LMN may make care costs HSA-eligible—eligibility depends on your plan.
Medicare covered — most patients $0
Chronic Care Management
Ongoing physician oversight for Medicare patients with two or more chronic conditions. Monthly care coordination, medication reconciliation, and 24/7 access. Billed under CPT 99490 ($60.49/patient/month at 2025 national average), 99439 (add-on $45.93), 99491, 99437. Most eligible patients pay $0 out of pocket after Part B deductible.
Medicare covered — most patients $0
Advance Care Planning
Document your wishes with physician support. A structured conversation that produces actionable advance directives — values, preferences, and instructions your family and care team can follow. Billed under CPT 99497 ($86.84 for first 30 min, 2025 Medicare rate), 99498 (+$78.16 per additional 30 min). Medicare-covered for eligible patients with no frequency limit.
Available to co-op.care families
Remote Patient Monitoring
MDR-certified monitoring via the myon.clinic platform. Physiological data — vitals, activity, weight — collected between visits and reviewed by our medical director. CPT 98975, 98977, 98980, 98981. Available to co-op.care families and health system partners.
Medicare covered
Principal Care Management
For patients with a single high-complexity chronic condition requiring intensive management. Monthly care plans, specialist coordination, and ongoing physician oversight. CPT 99424–99427 — $35–70 per patient per month. Medicare-covered.
Is telehealth right for this?
What telehealth can — and can’t — do.
Pick what you need. We’ll tell you honestly whether a remote physician practice is the right fit, what it costs, and where you’d be better served in person. We’d rather lose the booking than waste your $199.
Why Altru.care
Altru.care vs. telehealth vs. concierge
| Feature | Altru.care | Standard Telehealth | Concierge Practice |
|---|---|---|---|
| Can sign LMNs in your state | Yes — all 50 states | Depends on state | Local only |
| AI-drafted, physician-reviewed outputs | Yes — every document | No | Rarely |
| Chronic Care Management (CPT 99490) | Yes — Medicare covered | Varies | Rarely |
| LMN for HSA/FSA eligibility — $199 | Yes — $199 flat | Rarely offered | Sometimes |
| Advance care planning (CPT 99497) | Yes — Medicare covered | No | Sometimes |
| Ongoing clinical relationship | Yes — not one-time visits | No | Yes |
2025 Medicare reimbursement reference
What Medicare actually pays — per code, per month.
These are 2025 CMS national average rates. Actual reimbursement varies by geography and setting. Most eligible patients pay $0 out of pocket after their Part B deductible. The physician bills under her own NPI; Altru.care bills under the practice NPI.
| Service | CPT Codes | 2025 CMS Rate | Key requirement |
|---|---|---|---|
| Chronic Care Management — non-complex | 99490 | $60.49/mo | 2+ chronic conditions ≥12 months; 20 min care coordination/month |
| CCM — additional 20 min | 99439 | +$45.93/mo | Add-on to 99490; each additional 20 min documented |
| Advance Care Planning — first 30 min | 99497 | $86.84/session | Face-to-face with patient or family; 16+ min minimum; any frequency |
| ACP — each additional 30 min | 99498 | +$78.16 | Add-on to 99497; same encounter |
| Principal Care Management | 99424–99427 | $35–70/mo | Single high-complexity chronic condition; 30 min care plan/month |
| Remote Patient Monitoring — management | 99457, 99458 | $55–120/mo | 20 min/month; must include synchronous communication; 2+ reading days (2026 rule) |
A worked example: 10 CCM patients per month
A physician managing 10 Medicare patients under CCM — a modest panel — bills 99490 for each. At the 2025 national average:
(99490 only)
for 5 of 10 patients
from CCM alone
2025 CMS national average rates. Sources: Signal Lamp Health CCM Rates 2025 · PayerPrice 99497 Fee Schedule · CMS MPFS 2025. Geography and setting affect actual payment.
Request an LMN assessment
$199 flat · Physician-signed within 48 hours · HSA/FSA eligible
Common questions
Will my HSA or FSA accept this letter? ∨
An LMN signed by a licensed physician in your state is the standard documentation required by HSA and FSA administrators. Eligibility depends on your specific plan and the nature of the expense. Families using an LMN to run home care costs through an HSA save an average of $936 per year in federal taxes. Josh Emdur, DO confirms medical appropriateness before signing. If the letter is denied, you pay nothing.
Can you issue letters in my state? ∨
Yes. Josh Emdur, DO holds active licenses in all 50 states. He is a hospitalist at Boulder Community Health since 2008 and co-founder of co-op.care. The $199 flat fee covers his personal review, letter preparation, and signed PDF delivery within 48 hours.
What does the $199 cover? ∨
It covers the clinical review of your case, preparation of the Letter of Medical Necessity, physician signature, and delivery of the signed PDF to your inbox. No hidden fees. No subscription required. You are only charged after the letter is signed.
What is Remote Patient Monitoring (RPM)? ∨
RPM uses MDR-certified devices to collect physiological data (vitals, activity, weight) between clinic visits. Our medical director reviews data under CPT 98975, 98977, 98980, 98981. This service is available to co-op.care families and health system partners—contact co-op.care directly to enroll.
What is Chronic Care Management (CCM)? ∨
CCM is a Medicare program for patients with two or more chronic conditions. It includes monthly care coordination, medication reconciliation, care plan management, and 24/7 access to a care team. Billed under CPT 99490, 99491, 99437, 99439. Most eligible Medicare patients pay $0 out of pocket. Ask at intake whether you qualify.
What is Advance Care Planning (ACP)? ∨
ACP is a structured conversation with a physician to document your healthcare wishes — values, preferences, and instructions for your care team and family. It produces actionable advance directives. Billed under CPT 99497, 99498. Medicare-covered for eligible patients. ACP conversations are available through the co-op.care CareGoals platform.