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Introduction: We previously reported our amyotrophic lateral sclerosis (ALS) video televisit experience. Here we report on video televisit versus in‐clinic costs, adjusting for perceived medical usefulness (MU). Methods: We take the patient‐perspective and a focused institutional‐perspective. Costs are adjusted for patient/caregiver and physician perceptions of visit MU. The base‐case reflects our outpatient ALS practice. Results: In the base‐case, from the patient perspective, in‐clinic visits cost $1,116 and video televisits cost $89 ($119 after MU‐adjustment). From the institutional perspective, clinic visits cost $799, and video televisits cost $354 ($472 after MU‐adjustment). Adjusted cost‐savings per televisit are $997 (patient) and $327 (institution). Sensitivity analyses on 5 variables accounted for uncertainty in base‐case assumptions. Conclusions: Video televisits provide marked adjusted cost‐savings for patients …