Is telehealth appropriate for a first concussion visit?

Generally no. The initial diagnostic visit typically involves red-flag screening and exam components that are better performed in person, so most protocols reserve telehealth for follow-up rather than the initial evaluation.

Can balance and vestibular testing be done over video?

Not reliably. Standard balance testing (mBESS) and vestibulo-ocular screening (VOMS) depend on close physical observation and are generally recommended in person, though tele-adapted versions exist for patients with limited in-person access.

Does using telehealth for follow-up hurt recovery outcomes?

Available comparative data has not shown that telehealth follow-up impairs treatment decisions for routine concussion monitoring compared with in-person follow-up, though this evidence base is still developing relative to decades of in-person practice.

How often should a concussion patient be seen in person versus by telehealth?

There's no single mandated cadence, but a common pattern is an in-person initial visit, in-person visits whenever a hands-on exam (balance, vestibular, cervical) is needed, and telehealth for interval symptom and return-to-learn/return-to-play check-ins in between.

Can telehealth follow-up support RTM billing?

Structured, between-visit patient-reported monitoring data — whether reviewed on a telehealth visit or an in-person one — is the kind of documentation that supports Remote Therapeutic Monitoring billing. See RTM 98978 for the code most directly tied to cognitive-behavioral monitoring supply.

Can Concussion Follow-Up Be Done by Telehealth?

Yes, most routine concussion follow-up visits can be done by telehealth. Symptom-checklist review, return-to-learn and return-to-play progression counseling, and general monitoring translate reasonably well to video. Balance testing, vestibulo-ocular exam, and cervical spine exam are physical-exam-dependent and are generally better performed in person, especially at the initial diagnostic visit or when red flags are present.

Why This Question Comes Up

Concussion recovery is managed through a series of follow-up touchpoints rather than a single visit, and many of those touchpoints are largely conversational: how are symptoms trending, is the patient ready for the next step of return-to-learn or return-to-play, are there new concerns. That structure makes concussion follow-up a natural candidate for telehealth, particularly for patients who face access barriers — rural families, school-day conflicts, or households without reliable transportation to a specialty clinic. At the same time, several components of a thorough concussion visit are exam-dependent in ways that don't translate cleanly to a screen, which is why the honest answer is "yes, with structure" rather than an unqualified yes.

What Telehealth Handles Well

Symptom trajectory review. Reviewing a symptom checklist (for example PCSS) against the prior visit to confirm the patient is trending toward resolution.
Return-to-learn and return-to-play counseling. Walking a patient or family through the next step of a graduated protocol and confirming they tolerated the prior step without symptom exacerbation. See Return-to-Play Decision Criteria and Return-to-Learn.
Sleep and mood check-ins. Following up on sleep hygiene guidance or screening trends using patient-reported measures such as PHQ-9 or GAD-7.
Headache management follow-up. Confirming a post-traumatic headache treatment plan is working and screening for medication-overuse patterns; see Headache After Concussion.
Medication and activity-restriction adjustments that don't require a hands-on exam.
Access-limited populations. Pediatric patients and rural adults, where the alternative to a telehealth visit is often a delayed or skipped visit rather than an in-person one.

Available comparative evidence on telemedicine follow-up for concussion, including data presented through the American Academy of Neurology, has not shown that a telehealth follow-up format impairs treatment decisions relative to in-person follow-up for routine monitoring purposes. Telehealth has also been studied favorably for remote neurological follow-up in pediatric patients after brain injury, where access to specialty concussion care is often limited.

What Still Belongs In-Person

A telehealth-only model has real limits, and a defensible protocol should say so explicitly rather than defaulting every visit to video.

The initial diagnostic visit. Establishing the diagnosis, screening for red flags, and setting the baseline plan is generally better done face-to-face.
Any visit with red-flag features. Worsening headache, repeated vomiting, new focal deficit, increasing confusion, or other signs warranting escalation should not be triaged as a routine telehealth check-in. See Concussion Red Flags: When to Image.
Balance testing (mBESS). A physical balance assessment is not reliably reproducible on video.
Vestibulo-ocular exam (VOMS). Oculomotor and vestibular screening is one of the more sensitive clinic-based predictors of prolonged recovery, and it depends on close, controlled observation of eye movement and symptom provocation.
Cervical spine exam. Whiplash-associated symptoms are common after concussion and are a hands-on musculoskeletal assessment.

Some tele-adapted balance and oculomotor screening protocols exist and can be reasonable when in-person access is genuinely limited, but they are a compromise, not a substitute for a full clinic exam when one is feasible.

A Practical Hybrid Model

A pragmatic pattern reflected in current practice is: in-person for the initial visit and for any visit that requires a hands-on balance, vestibular, or cervical exam, with telehealth used for the interval symptom and return-to-learn/return-to-play check-ins in between. This keeps the exam-dependent decisions anchored to a physical visit while using telehealth to close the gap between those visits, which is where most patients otherwise fall off the follow-up schedule entirely. See Concussion Follow-Up Schedule for typical visit cadence.

This model is especially useful for patients who are recovering as expected — where the clinical question at each interval visit is largely "confirm progress, advance to the next step" — and less useful once symptoms plateau or exceed the expected recovery window, at which point closer, often in-person, multidisciplinary follow-up is warranted. See Managing Persistent Post-Concussive Symptoms.

Documentation Still Matters on Telehealth Visits

Whether a follow-up happens by video or in person, the documentation burden is the same: a symptom trajectory that supports the clinical decision made, and a record of what was assessed. Structured, dated symptom and screening data collected between visits — not just at the visit itself — gives a telehealth follow-up more to work with, since the clinician isn't relying solely on the patient's recall of "how the week went." That data also supports Remote Therapeutic Monitoring billing where a practice has structured monitoring in place between visits; see How to Bill Concussion Follow-Up and RTM 98978.

How Kavera Handles This

Telehealth is built into Kavera. Monthly follow-ups run inside the platform with the week's check-ins, cognitive scores and brain-training completion already on screen, and the session is logged as interactive communication for 98979/98980. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.