Physician Practice · multiple states
Care for someone who can't
manage on their own
is medical care.
When a person is chronically ill — unable to perform two everyday activities without help for 90 days or more, or needing constant supervision for their safety — their personal and maintenance care is already medical care under IRS §213(d), by way of §7702B(c). A physician certifies that and prescribes the plan of care it follows from. We don't turn wellness spending into a medical expense — and when the standard isn't met, we say so.
$199 flat, and only when the standard is met. If it isn't, you hear it — at no charge — before you pay.
A family paying $2,400/month for a home health aide — care for a parent who can no longer bathe or dress unassisted — documented $28,800 of qualified long-term care. Tax savings at 27%: $7,776 back. See how the letter works →A letter documents care that already qualifies — it cannot make a personal expense medical. Eligibility depends on the diagnosis, the plan of care, and your plan's rules.
Medical Director, DO
BCH hospitalist since 2008 · multi-state licensure · 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.
Start the intake ↓A physician reviews and signs
Sage AI prepares a draft based on your intake. Our medical director — a licensed physician — personally reviews every case, edits as needed, and signs each letter himself. No batch processing. No unlicensed staff.
See how physicians review →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.
Every signature, hash-anchored →Clinical services
Altru.care is a physician-owned medical practice. co-op.care is the worker-owned care cooperative its medical director supervises clinically. Both are real services; they are separate entities. The medical director signs every LMN personally.
Primary service
Letter of Medical Necessity
Makes home care, wellness services, and medical equipment costs reimbursable through HSA or FSA. Signed after a real clinical evaluation — never from a questionnaire. A letter documents care that already qualifies — it cannot make a personal expense medical.
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 — multiple 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
See all billable services →
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.
Before you pay $199
Will my expense likely qualify?
Three questions, thirty seconds. An LMN needs a genuine medical basis — if yours is missing one, we’d rather tell you now than take your $199.
Is the expense for someone with a real medical need — a diagnosed condition, a recovery, or something like memory decline that makes daily life unsafe?
Would the expense directly help treat or manage that need — home care or companion care hours, wellness services, or medical equipment?
Honestly — would you be making this purchase anyway, even if the health issue didn’t exist?
A quick gut-check, not a clinical determination. Our medical director confirms medical appropriateness on every intake before signing — and you pay nothing if the letter is denied.
Request an LMN assessment
$199 flat · Practitioner evaluation · documented plan of care
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 — see how ComfortCard tracks HSA/FSA savings →. Our medical director confirms medical appropriateness before signing. If the letter is denied, you pay nothing.
Can you issue letters in my state? ∨
Yes. Our medical director is licensed in multiple states, has practiced as a hospitalist at Boulder Community Health since 2008, and is a co-founder of co-op.care — read the founding story →. 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. Curious what Medicare pays for comparable services? See the 2025 rate reference →
What is Remote Patient Monitoring (RPM)? ∨
RPM uses MDR-certified devices to collect physiological data (vitals, activity, weight) between clinic visits, delivered via the myon.clinic platform. 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. CCM often pairs with home-based systems for ongoing support — see careho.me → for age-in-place tools.
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 start on the CareGoals → platform.