Telehealth neurology, also called teleneurology, allows neurologists to assess, diagnose, and sometimes treat neurological conditions without requiring an in-person visit. According to the American Medical Association's 2021 telehealth survey, more than 80% of physicians agree or strongly agree patients have better access to care since they began using telehealth.
But for neurologists, the benefits go beyond access. With growing demand for neurological services and a limited supply of specialists, many neurology practices face scheduling bottlenecks, particularly when diagnostic workflows depend on lengthy neuropsychological referrals. Telemedicine, paired with the right digital tools, offers a path to streamline those workflows, reduce patient backlogs, and maintain continuity of care for complex neurological conditions.
This article covers how neurologists use telemedicine for stroke, epilepsy, multiple sclerosis, and cognitive assessment, the benefits and limitations of virtual visits, reimbursement, and how to integrate telemedicine into a neurology practice.
Article Highlights
- Telehealth neurology, also called teleneurology, lets neurologists assess, diagnose, and sometimes treat neurological conditions without an in-person visit.
- 98% of neurologists use telehealth in some capacity, according to the American Medical Association's 2021 survey.
- Telemedicine can improve adherence to disease-modifying therapies in people with multiple sclerosis.
- Key applications include stroke care, epilepsy, multiple sclerosis, and cognitive screening.
How widely do neurologists use telehealth?
The American Medical Association's 2021 telehealth survey indicates that 98% of neurologists use telehealth in some capacity in their practice. Many neurology departments and hospitals also indicated offering telehealth appointments for patient convenience.
For neurologists managing growing caseloads, the ability to conduct follow-up visits, review lab results, discuss symptoms, and evaluate treatment response virtually means fewer scheduling bottlenecks and shorter appointment times for routine care, freeing up in-person visit slots for patients who need in-person neurological examination.
Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers.
Telemed J E Health, 2019
Which neurological conditions can telemedicine help manage?
Telemedicine supports the management of both acute and chronic neurological conditions, including stroke, epilepsy, and multiple sclerosis, as well as cognitive assessment and screening.
Stroke care
Telemedicine for stroke, often called telestroke, typically involves a real-time interactive communication system between the patient and a remote specialist. This allows neurologists to evaluate the patient, review brain imaging results, and make critical treatment decisions, even if the patient is at a remote site or hospital. Telemedicine also plays a role in post-stroke management, with regular virtual follow-ups and rehabilitation monitoring helping maintain care continuity during recovery.
Epilepsy management
The nature of epilepsy, with its unpredictable seizures and the need for ongoing medication adjustments, makes it a prime candidate for telemedicine. Through remote monitoring, doctors can keep track of seizure frequency and severity without requiring patients to come into the clinic. Virtual consultations allow neurologists to adjust medication dosages and discuss treatment plans in real time, which is especially beneficial for patients who live far from their neurologist or have mobility issues.
Multiple sclerosis monitoring
Multiple sclerosis (MS) patients can greatly benefit from telemedicine through remote monitoring and virtual visits. MS often affects mobility, making travel to appointments challenging, and the condition's unpredictable flare-ups mean patients need to communicate quickly with their neurologist about changes in symptoms. Telemedicine allows for consistent, remote monitoring of disease progression, particularly valuable for patients in rural areas who may not have easy access to a neurologist.
Cognitive assessment and screening
One of the most significant workflow challenges neurologists face during telemedicine visits is being unable to administer standardized cognitive assessments. Traditional pen-and-paper screeners like the Montreal Cognitive Assessment (MoCA) or Mini-Mental State Examination (MMSE) require in-person administration, and a video visit alone doesn't provide the objective cognitive data needed to diagnose conditions like mild cognitive impairment (MCI) or track cognitive decline over time.
Digital cognitive assessment platforms can help address this gap. Online cognitive testing can be performed virtually (before, during, or after a telemedicine appointment), giving neurologists access to domain-specific cognitive data without requiring a separate in-person visit or a lengthy referral to neuropsychological testing. For practices managing high patient volumes, this is a meaningful workflow improvement.
How do virtual visits benefit neurology patients?
A teleneurology program offers numerous benefits for neurology patients, including:
- Convenience: Virtual visits eliminate travel burdens for patients who face long distances, mobility challenges, or difficulty taking time off work.
- Access to specialty care: Telemedicine extends neurology coverage to communities with limited availability of neurologists.
- More frequent follow-up: Easier scheduling means more regular checkups, improving disease management and monitoring.
- Comfort: Receiving care from home may cause patients less stress and anxiety, particularly for those with memory loss or mobility issues.
A 2022 systematic review of telemedicine during the COVID-19 pandemic found consistently high patient satisfaction across studies and specialties. Higher patient satisfaction is also associated with better treatment adherence and persistence, which in practice means greater follow-through on clinician recommendations and fewer missed follow-up visits.
That said, virtual visits may not suit every clinical scenario. Certain complex neurological conditions may require hands-on examination, and new symptoms including falls, tremors, and vision changes may not be fully assessed through a video visit alone.
Challenges and limitations of telemedicine in neurology
Despite its advantages, telemedicine in neurology has challenges that neurologists need to address:
- Exam limitations: Performing a comprehensive neurologic exam remotely remains difficult, and administering standardized cognitive assessments without a digital platform creates a gap in the diagnostic workflow for conditions like MCI and dementia.
- Privacy and security: Health Insurance Portability and Accountability Act (HIPAA) compliance requires careful attention when choosing telemedicine platforms and building workflows.
- Accessibility: Technology barriers, digital literacy gaps, and disparities in internet access can limit who benefits from telehealth neurology.
- Patient preferences: Some patients prefer in-person interaction, and clinicians may find it harder to assess nonverbal cues through a screen.
Cognitive assessment platforms designed for remote administration can help address the exam limitation, enabling neurologists to gather objective cognitive data without requiring a separate in-person appointment.
Reimbursement for telehealth neurology
Most insurance companies now have policies in place for telemedicine reimbursement. Medicare and Medicaid have expanded their coverage to include telemedicine services, and private insurers are increasingly covering virtual visits, though rates and specifics vary by payer and state.
Beyond standard evaluation and management (E/M) codes, neurologists should explore reimbursement pathways for cognitive testing performed remotely. Digital cognitive assessment platforms may open reimbursement pathways under neuropsychological testing CPT codes. Automated test administration can be billed under CPT 96146, while the physician's time interpreting results, integrating them with clinical data, and preparing reports may be billed under CPT 96132–96133, potentially creating a new revenue stream while streamlining diagnostic workflows. Coverage varies by payer and state, so neurologists should verify reimbursement terms with each insurer.
How to integrate telemedicine into a neurology practice
Successful integration of telemedicine into a neurology practice requires:
- Analyzing current diagnostic workflows to identify where bottlenecks occur, particularly in cognitive screening, testing, and referral pathways.
- Selecting a telemedicine platform that integrates with your electronic health record (EHR) and supports HIPAA-compliant video visits.
- Choosing a digital cognitive assessment platform that supports remote, standardized testing, reducing reliance on external neuropsychology referrals while maintaining diagnostic accuracy.
- Training staff on the technology, including how to administer remote assessments and communicate results.
- Setting up protocols for which visit types are appropriate for virtual care, how to escalate to in-person when needed, and how cognitive assessment data will be incorporated into documentation.
- Evaluating and refining processes based on patient satisfaction, clinical outcomes, and workflow efficiency.
The U.S. Department of Health and Human Services has issued guidance clarifying that clinicians should conduct telehealth in private settings and implement reasonable HIPAA safeguards to protect patient health information.
Written by Mike Battista, Director of Science & Research at Creyos
Mike Battista specializes in brain health, cognition, and neuropsychological testing. He received his PhD in personality and measurement psychology at Western University in 2010 and has been doing fun and useful stuff in the intersection between science and technology ever since.