A Letter of Medical Necessity, a wellness visit's prevention plan, an advance care planning discussion, a month of remote monitoring — different codes, one requirement underneath. Somebody licensed reviewed it, decided, and put their name on it. We make that step take minutes and leave a record anyone can check.
Every service on this page has the same shape. Automation is good at the first step and useless at the second — and the second is what payers, plan administrators and auditors are actually paying for.
A care plan, a letter, a monitoring summary, a discussion note. Increasingly by AI, from real data.
Specialty-matched, licensed in the patient's state, paid a flat fee whichever way the answer goes. Minutes, not days.
NPI-bound, timestamped, hash-anchored. What was reviewed, under which criteria, on what day — checkable years later.
The claim has its required signature; the letter has its basis; the audit has an answer that cannot be rewritten after the fact.
Codes and program rules below are the billing context our partners work in — they are not our determinations, and nothing here is coding or billing advice. What we supply in each case is the attested record.
Pre-tax spend on a dual-purpose product or service. Eligible only if it treats a diagnosed condition — the but-for test, applied one person at a time.
Medicare's yearly prevention visit: a health risk assessment and a personalized prevention plan. The assessment is exactly the kind of structured intake software does well.
A voluntary discussion of goals of care and advance directives, billed in time increments. Almost always involves a family member, and almost never gets documented as carefully as it deserves.
Device supply and treatment management for musculoskeletal, respiratory and adherence data — the exercise-therapy category's clinical twin. For 2026 CMS added 2–15 day device codes and a 10–19 minute management code, which require at least one real-time interactive communication with the patient or caregiver in the month.
Setup, device supply and clinical management time for physiologic data — blood pressure, glucose, weight. 2026 adds a 2–15 day device code and a 10–19 minute management code. Note CMS treats RPM and RTM as non-face-to-face services, not telehealth — a different rulebook and a different clock.
Ongoing management of chronic conditions between visits, with a care plan that has to be established, reviewed and revised.
The days after discharge — the window where families are most overwhelmed and where co-op.care's work already sits.
Personal and maintenance care becomes a qualified medical expense when it is required by a chronically ill individual — certified by a licensed practitioner as needing substantial assistance with two or more activities of daily living for 90 days, or substantial supervision for severe cognitive impairment — and delivered under a plan of care prescribed by a licensed practitioner. The certification must be renewed every twelve months.
Medicare now pays a clinician to train a family member in the strategies and techniques that keep the patient functioning at home — transfers, fall hazards, memory aids, device use. Confirm the current code set and coverage rules with your billing team before you rely on them.
Group behaviour-management training for caregivers of patients with a diagnosed condition — the dementia support group, made billable. Code set and coverage rules to be confirmed with your billing team.
Community health integration and principal illness navigation pay for the unglamorous work — coordinating services, addressing the barriers that stop a care plan from happening at home.
Collaborative care, where a consulting psychiatrist's review is a structural requirement of the model.
The GUIDE Model — Guiding an Improved Dementia Experience — is a voluntary nationwide CMS Innovation Center model for dementia care management, offering care coordination and management alongside education, support and respite for unpaid caregivers. Both tracks run through 30 June 2032: 96 established-track participants began on 1 July 2024, and 294 new-track participants began on 1 July 2025. Respite is a separate payment on top of the care-management payment, capped per aligned beneficiary per year — CMS's programme materials put it at up to $2,500, and the current year's figure should be taken from CMS directly.
Alongside it sit the caregiver training services Medicare added to the physician fee schedule, which pay a clinician to train the daughter, the spouse, the son — in some cases with the patient not present. Every one of these requires a clinical basis, a plan tied to a diagnosis, and a clinician who stands behind it. That is a determination, and determinations are what we do. The family is not a bystander to the reimbursement; in this part of medicine they are the care being reimbursed.
CMS's Advancing Chronic Care with Effective, Scalable Solutions model is a ten-year voluntary model that began on 5 July 2026, testing outcome-aligned payment in Original Medicare for technology-supported chronic care. It targets the conditions affecting most of the Medicare population — high blood pressure, diabetes, chronic musculoskeletal pain, depression — and participants must report outcomes and share clinical updates through FHIR-based APIs.
More than 150 organisations had been accepted by 17 August 2026, according to CMS, and most of them had never served Medicare beneficiaries before. Private payers covering a very large commercial, Medicaid and Medicare Advantage population have committed to aligning with the model's payment approach. That is a large group of digital health companies suddenly holding clinical oversight, licensure and outcome-reporting obligations they have never had to satisfy.
This is our market, arriving on a schedule. Outcome-aligned payment means somebody has to vouch that the outcome data and the clinical decisions behind it are real. Free pipes, paid brain: the FHIR connectors are commodity, and the physician standing behind the output is not.
Advance care planning, transitional care, chronic care management, aging at home, and most HSA spend on a dependent parent — in all of them the person answering questions, buying the service and managing the care is a family member. Software in this space keeps assuming otherwise.
The caregiver's relationship is captured and the physician sees which answers came from the patient and which from the family. A determination built on a daughter's best guess, presented as the patient's own account, is what unravels later.
The reviewing physician is licensed where the patient is, not where the payer or the caregiver is.
An HSA can pay qualified expenses for a spouse or tax dependent. One attested determination about one condition can support the equipment, the home modification and the care hours that follow from it.
Exhausted families are the easiest people to sell a bad letter to. A written no, at no cost, with a reason, is the most protective thing this product does.
The same record shape whatever was attested — an LMN determination, a prevention plan, a monitoring month. Health data stays in the case; only the fingerprint goes public.
Scale here means a physician's judgment reaches more decisions — not that fewer judgments are made. Every attestation is individual, every reviewer is paid the same for a no, and a service is only offered once its criteria are written and signed off by the medical director.
Nothing on this page is billing, coding, legal or tax advice, and none of it is a guarantee of payment. Codes and program rules change; your billing decisions are yours. LMN determinations are live in pilot; the remaining services are in design. No BAA is executed yet, and pilots run on synthetic data until clinical sign-off and privacy safeguards are complete.