Neuropsychological assessment can play a vital role in competency to stand trial (CST) evaluations. This article provides an overview of the brain and behavior-based conditions that may impact an individual's ability to participate in their legal proceedings, as well as the relevant legal parameters that guide these types of forensic mental health evaluations. Circumstances that may warrant the involvement of a neuropsychologist in these evaluations are reviewed. For example, neuropsychologists' expertise with validity testing, as well as their specialized knowledge of cognition, is useful from the onset of the evaluation through the end, where involved parties often want to know about restoration interventions and feasibility. Select neuropsychological testing measures and cultural considerations are also addressed. The article concludes with illustrative case examples that demonstrate the real-world application of neuropsychological involvement in this specific forensic context. Given the expanding opportunities for neuropsychologists to assist triers of fact, this work contributes to the necessary and developing education base for neuropsychologists who wish to provide informed, effective, and culturally sensitive CST evaluations or related consultation to the legal system.