Coronavirus (COVID-19)

As the impact of COVID-19 unfolds, the Academy of Nutrition and Dietetics is gathering resources for food and nutrition practitioners to address preparedness, patient care and food safety and access.

Professional Resource Hub


  • Stay informed and follow recommendations of local and federal agencies.
  • Perform within your individual scope of practice.
  • Request training and document competence in new tasks and services.
  • Use the best available evidence-based guidance and resources.

On March 11, 2020, the World Health Organization declared the coronavirus disease, more commonly known as COVID-19, a pandemic due to the number of individuals and countries affected. As a result, many changes in our daily lives are being recommended in order to minimize the spread of COVID-19, including the ones identified in the President's Coronavirus Guidelines for America.


It's important for nutrition and dietetics practitioners to stay informed of updates and to reinforce the importance of following the recommendations of local and federal government agencies to their patients and clients.

The Centers for Disease Control and Prevention and other agencies, including the U.S. Food and Drug Administration, continue to monitor the outbreak and have issued guidance for both consumers and healthcare professionals alike. Access to critical medical care and safe, nutritious food are being addressed on many levels. There may be additional factors to consider depending on where you reside or the setting in which your practice.

The Academy supports access to medical nutrition therapy services for all citizens during the current public health emergency and efforts to ensure access to food during the COVID-19 response. Measures are being taken to expand telehealth coverage in accordance with the Coronavirus Preparedness and Response Supplemental Appropriations Act, which was passed by Congress and signed into law by the President on March 6. In addition, the U.S. Department of Health and Human Services is working with many agencies in order to provide ongoing nutrition assistance during the pandemic and has issued guidance for these programs.

The Academy is keeping its members up to date through several communications vehicles. Stay informed as new resources and guidance become available by:


During the COVID-19 pandemic, RDNs and NDTRs may be asked to expand duties and services as a credentialed practitioner, including screening, treatment and care of COVID-19 patients, as well as taking temperatures and blood pressure, triage/screening and listening to lung and bowel sounds.

While it can be within a credentialed practitioner's scope to assist with COVID-19 through their organizations and practice settings, each practitioner should ensure the duties being performed are within their individual scope of practice.

For example, some RDNs have been trained in the placement of enteral tubes at the patient's bedside and should be encouraged to assist with these procedures as training and facility policy allows. Other RDNs should assist only if they demonstrate and document competence through on-site facility training by their organizations during the COVID-19 response. RDNs with limited experience in caring for patients in intensive care units or who require enteral or parenteral nutrition should collaborate with the physician and pharmacist to order and monitor these therapies to support safe and quality care.

In these unusual times, RDNs and NDTRs are being asked to contribute to patients in critical care in ways that some practitioners may not have previously in their practice. Be open to contributing and learning new skills, but practitioners should ask for training to ensure they have the demonstrated and documented competence to perform the activity.


This working list of resources will be expanded over time, so check back often. Academy members also are welcome to make suggestions of other science-based resources our staff RDNs should review and consider.

Critical Care Resources


Enteral/Parenteral Nutrition

Financial/Business and Funding

Food Security, Food Waste and Hunger

General Information

Kidney and Renal Disease

Pregnancy and Infant Feeding

Preparedness and Response

Standards of Practice/Standards of Professional Performance

  • Journal article: Why Do Practitioners Need to Read the Revised 2017 Scope/Standards Documents? (no login)
  • Standards of Professional Performance (SOPP) for RDNs in Nutrition Care — Standards Indicators are as follows:
    • 2.10 Pursues opportunities (education, training, credentials, certifications) to advance practice in accordance with laws and regulations, and requirements of practice setting
    • 3.1 Contributes to or leads in development and maintenance of programs/services that address needs of the customer or target population(s)
    • 3.1A Aligns program/service development with the mission, vision, principles, values, and service expectations and outputs of the organization/business
    • 3.1B Uses the needs, expectations, and desired outcomes of the customers/populations (eg, patients/clients, families, community, decision makers, administrators, client organization[s]) in program/service development
    • 3.1C Makes decisions and recommendations that reflect stewardship of time, talent, finances, and environment
    • 3.1D Proposes programs and services that are customer-centered, culturally appropriate, and minimize disparities
    • 3.4 Executes programs/services in an organized, collaborative, cost effective, and customer-centered manner
    • 3.4A Collaborates and coordinates with peers, colleagues, stakeholders, and within interprofessional teams

Telehealth and Nutrition Services


This Q&A section is intended to provide members with information believed to be current and accurate at the time of posting, and will be refined and updated as new information becomes available. (It is not intended as, nor should be construed as, legal, financial, medical, or consulting advice. RDNs and NDTRs should exercise their professional judgment in connection with this information.)

Ask a Question


Prior to COVID, my hospital utilized the MST to screen for patients at nutrition risk upon admission. Since the pandemic, documentation has been significantly altered to minimize charting for the nurses and the MST has been eliminated. How should we screen for patients at nutrition risk while still maintaining evidence-based practice?

If the patient does not have COVID-19 and is not suspected of having COVID-19, it is recommended that the facility standards of practice protocol for malnutrition be executed when possible. If nursing staff is not be able to complete the nutrition screen, RDNs and nutrition staff may conduct the screen and assessment. If it is not possible to implement a nutrition screen or assessment, we suggest using other tools that are available to the RDN, i.e.; BMI, existing diagnosis, problem list and list of co-morbidities.

Answered April 3, 2020

Are there nutrition support recommendations for critically ill patients with COVID-19? When should nutrition support be initiated and what route is recommended?

The American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM) have released recommendations for nutrition therapy in the patient with COVID-19 disease requiring ICU care, which we have listed as a resource above. Additionally, the following resources address nutrition care for critically ill patients who require nutrition support.

Evidence Analysis Library (EAL): Critical Illness Guidelines (2012)
Reviews recommendations on nutrition interventions for critically ill adult patients, including enteral vs parenteral nutrition, initiation of enteral nutrition, tube feeding placement and more.

The Academy's Nutrition Care Manual
Includes an entire section dedicated to critical illness, including information specific to nutrition support. This section discusses time frames for initiation of both enteral and parenteral nutrition, enteral formula selection, and potential complications to monitor for after nutrition support has been initiated.

The Academy's Pediatric Nutrition Care Manual
Includes a section specific to critical care for pediatric patients, as well as nutrition support considerations and nutrition care FAQs.

ASPEN: Resources for Clinicians Caring for Patients with Coronavirus
Provides resources for both enteral and parenteral nutrition, including the Guidelines for the Provision and Assessment of Nutrition Support in the Adult Critically Ill Patient, which discusses recommendations for when nutrition support should be initiated.

The following journal articles also may be helpful for critical care patients who are on mechanical ventilation or where prone position is a concern:

Snyder, DM. (2013). The Impact of Various Ways the Dietitian Makes Recommendations in a Medical Intensive and a Neuroscience Intensive Care Unit for Mechanically Ventilated Patients Requiring Nutrition Support. The Journal of the Academy of Nutrition and Dietetics. 113(S9), A19.

Saez de la Fuente, I., Saez de la Fuente J., Delicias Quintana Estelles, M., & et al (2016). Enteral Nutrition in Patients Receiving Mechanical Ventilation in a Prone Position. Journal of Parenteral and Enteral Nutrition. 40(2), 250-255.

Updated April 8, 2020

What are other hospital food services doing for patient trays? Are they using throw away products or are they still using washable products?

According to the CDC Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings — Revised March 10, 2020, "Management of laundry, food service utensils, and medical waste should also be performed in accordance with routine procedures." During this time, it may be necessary to additionally consult state or local health departments for guidance.

Here are resources that may be helpful:

Answered March 30, 2020

If training is provided and competence is documented, would it be considered in scope for RDs to perform swabs for COVID-19 testing?

The short answer to your question is yes, with training and documented competence it could be in the within the RDN's individual scope of practice to perform swabs for COVID-19 testing.

During the COVID-19 pandemic, RDNs are being asked to expand duties and services as a credentialed practitioner. Each RDN should ensure the duties being performed are within their individual scope of practice. Expanded duties can be within the RDN's individual scope of practice to assist with COVID-19 through their organizations and practice settings.

Duties may include screening, treatment and care of COVID-19 patients as well as taking temperatures, blood pressures, triage/screen and listening to lung and bowel sounds. RDNs should ensure to only assist if they demonstrate and document competence which can be accomplished through facility training by their organizations during the COVID-19. Many RDNs are seeking out and are being proactive in ensuring that they are being trained in these activities and responsibilities.

In these unusual times, RDNs are all being asked to step up and contribute to patients in critical care in ways that you as an RDN may not have done in your current practice. Be open to learning new expanded roles. Ask for training so that what you do, provides quality care and positive outcomes for patients. Stay safe, stay healthy.

Answered March 30, 2020

Can you direct me to resources regarding nutrition during pregnancy for emergencies or pandemic events?

Here are some resources that may be helpful:

Answered March 27, 2020

I am a dietitian in long term care/subacute rehab. Are dietitians allowed to feed residents/patients? If so, are there written practice guidelines indicating this? And if you have any information about a dietitian teaching other non-clinical staff how to feed, I would greatly appreciate it.

In short, the answer to your questions about dietitians being allowed to feed residents/patients and teach other non-clinical staff is “yes.”

As noted in the Academy of Nutrition and Dietetics: Revised 2018 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Post-Acute and Long-Term Care Nutrition, RDNs working in PAC/LTC:

  • "Reviews and evaluates cognitive and physical ability to engage in nutrition-related ADLs (eg, dexterity, self feeding skills, ability to use adaptive eating devices, and need for assistance with eating and drinking)"

This denotes that RDNs are qualified not only to oversee but to also assist patients with feeding and conduct Feeding Assistant Training programs. Although the Academy has not developed any specific criteria surrounding feeding assistance, there is much information available online based on various state regulations. Please review your state's laws and regulations to find out about conducting a training.

RDNs conducting and developing various trainings is noted several places in the 2017 RDN Scope of Practice.

  • "…plan and deliver training and education for health personnel; and advocate for sound food and nutrition legislation, policies, and programs at the federal, state, and local levels."
  • "Provide training and education to teams ensuring competent nutrition professional and foodservice workforce."
  • "Ensure the employee workforce is engaged in the vision for services through training, mentoring, opportunities to give input, and with clear expectations for performance and accountability."

You can access the full scope here.

Answered March 27, 2020

I have been reading in the news that vitamin C is being used to treat COVID-19 with success. Is there any validity to these stories? Also, can it hurt to take vitamin C supplements? Can you take too much vitamin C?

Although there have been recent news reports of some health care facilities administering high doses of vitamin C intravenously to COVID-19 patients, this form of treatment and other therapeutics are currently being investigated.

The role of vitamin C in the treatment of COVID-19 has not been well studied and there is currently no published research looking at the effect of supplementation of vitamin C on the prevention or treatment of COVID-19.

Some studies in the past have shown that oral vitamin C supplementation may shorten the duration of the common cold or its severity, but the findings have been mixed. There is currently no data to suggest that vitamin C supplements can prevent respiratory infections in the general population, nor are there studies on oral vitamin C supplementation on COVID-19 at this time.

A randomized controlled trial is currently underway in Wuhan China, and it will be evaluating the clinical efficacy and safety of intravenous vitamin C infusions for the treatment of severe COVID-19 pneumonia.

As more information becomes available, agencies in the United States, such as the Centers for Disease Control and Prevention will continue to update the Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19).

Vitamin C, or ascorbic acid, is a water-soluble vitamin found in many fruits and vegetables. The recommended daily allowance, or RDA, of vitamin C in individuals 19 years and older is: 90 mg a day for men; 75 mg a day for women; 85 mg a day for pregnant women; and 120 mg a day for women who are breastfeeding. Individuals who smoke require an extra 35 mg a day above the RDA.

In most situations, it is relatively easy to get the recommended amounts of vitamin C through foods and therefore, supplements are not generally recommended.

The tolerable upper level intake of vitamin C is 2000 mg per day for individuals 19 years and older. According to the National Institutes of Health, vitamin C has low toxicity but high intakes are not recommended. The most common complaints regarding supplementing with vitamin C are diarrhea, nausea, abdominal cramps, and other gastrointestinal irritations.

Answered March 26, 2020

I'm working as dietitian in a hospital right now, am I considered essential? Does it make a difference if I'm doing inpatient or outpatient care? What exactly is an essential job?

The Cybersecurity and Infrastructure Security Agency (CISA) of the U.S. Department of Homeland Security provides guidance that is "intended to support State, Local, and industry partners in identifying the critical infrastructure sectors and the essential workers needed to maintain the services and functions" that Americans depend on during the COVID-19 pandemic. This guidance is not binding but rather serves as a starting point for local and state governments to identify key groups of employees during the pandemic response.

According to the U.S. Food and Drug Administration, critical infrastructure industries, including many FDA-regulated industries such as food, drugs, and medical equipment, "have a special responsibility in these times to continue operations."

There are currently 16 designated "Critical Infrastructure Sectors," many of which employ nutrition and dietetics practitioners.

Answered March 26, 2020

Should clinical RDNs wear a mask? Should we do face-to-face consults?

According to the CDC, healthcare personnel should wear personal protective equipment, or PPE, such as gowns, gloves, eye protection (goggles or face shields, not personal eyeglasses or contacts) and a face mask if an N95 respirator is not available when in prolonged contact with patients who are infected with COVID-19.

To protect healthcare personnel, installing barriers to limit contact with patients and limiting the number of staff providing face-to-face consults is encouraged. If it is possible to care for a patient who is infected without face-to-face consults, then it should be done. To help preserve staff and personal protective equipment, as well as ensure staff and patient safety, the CDC recommends delaying elective ambulatory visits during the COVID-19 pandemic. Telehealth options or reduced face-to-face interactions may be encouraged at some healthcare facilities to help with these measures.

The CDC offers methods for assessing risk exposure for healthcare professionals who work in settings that provide care for patients with confirmed COVID-19 or are being tested for it.

Answered March 24, 2020

Homemade infant formula recipes and claims of formula shortages are popping up all over the internet. This is a true safety concern for our infants. How should RDNs respond?

Currently there are no reported shortages of baby formula. If a local store is low or out, it is most likely due to shopper stockpiling and because stores have not yet adjusted inventory levels to make up for the demand. Individuals looking for formula are urged to check other stores and visit the manufacturer's website to search for store locations. To save time and limit exposure to the public, encourage parents to call and ask about formula availability before visiting stores. When purchasing formula, parents are being advised to purchase no more than a supply of formula that will last 10 days to 2 weeks; although stores may be limiting the amount which can be purchased at one time.

The American Academy of Pediatrics and the U.S. Food and Drug Administration does not recommend making homemade baby formula. Homemade formula can cause harm to infants. It is recommended that infants only be fed breastmilk or iron-fortified infant formula that has been commercially prepared to meet the FDA's nutrient requirements. Even if it's just for a few days, feeding babies homemade formula can put them at risk. It is also recommended that infant formulas be prepared according to the package directions. If parents are considering switching formulas, they should seek the advice of their pediatrician first.

According to the AAP, the following should never be fed to infants:

  • Homemade formula with ingredients like powdered cow's milk, raw milk or sugar; plain cow's milk; or milk substitutes like almond or soy milk. They do not have the correct balance of ingredients for infant nutrition.
  • Imported infant formula. It might have too much or not enough of some ingredients. If it was not stored or shipped correctly, it could be unsafe to use.
  • Watered-down formula. It provides an unbalanced diet and can cause serious growth problems. It provides an unbalanced amount of nutrients and can cause serious growth problems.

For parents struggling to find or afford infant formula, local foodbanks may provide free infant formula. Visit the Feeding America food bank map to find a local food bank.

Additional resources include:

Answered March 24, 2020

I am seeing a lot of information on social media about supplements to prevent or protect against COVID-19. What are the best resources to share to clear up misinformation?

Currently, there are no known cures for COVID-19, though research is underway to develop a vaccine. In its continuing efforts to protect consumers, the U.S. Food and Drug Administration, or FDA, has been monitoring and warning companies that offer fraudulent products which claim to help prevent, diagnose, treat or cure COVID-19.

Untested supplements and other products touted as a prevention or cure to COVID-19 that are not regulated by the FDA may be dangerous and potentially life threatening. The U.S. Federal Trade Commission, or FTC, and FDA have jointly issued warning letters to sellers of unapproved and misbranded products claiming they can treat or prevent the virus. Learn which companies have received warning letters and sign up for consumer alerts.

Avoid this, and other coronavirus-related scams with these tips.

Answered March 24, 2020

Business and Telehealth

Are self-reported weights acceptable for patients/clients seen via telehealth when a recorded weight is a program requirement (such as for IBT for obesity services, diabetes prevention programs, or bariatric surgery programs)?

We have seen some guidance from the CDC for diabetes prevention programs that CMS announced they will be following. So, while this information is not specific to other obesity/weight management services, including bariatric surgery, we believe it may also be acceptable for those services. Weights can be obtained via digital technology, such as Bluetooth-enabled scales, or you can accept a self-report from a patient's at-home digital scale. A third option would be for the patient to send you a photo of the reading from their scale. For either of the latter two options, you would document in the medical record that the weight was self-reported as part of the service being delivered via telehealth during the COVID-19 public health emergency.

Answered April 3, 2020

Do the new Medicare telehealth flexibilities allow RDNs working in Long-term Care (LTC) facilities allow billing and payment for the nutrition assessments completed by the RDN?

Services provided by RDNs in long-term care facilities are not separately reimbursable services, so there are no changes related to billing and payment in this setting. Based on procedures put in place by your LTC facility to prevent spread of the coronavirus, you may be asked to complete your assessment via phone from the nursing station or home. You should follow your facility's policies for doing so.

Answered April 3, 2020

Are the "G" codes for online assessment and management services for established patients (G2061, G2062 and G2063) used by private payers and Medicaid?

Private payers may elect to cover and pay RDNs for use of G2061-G2063 or the equivalent CPT codes 98970, 98971 and 98972. RDNs can inquire with private payers and Medicaid to determine policies regarding use and payment.

Answered April 3, 2020

What is the difference between the Online Assessment and Management Service Codes and Telehealth?

Under Medicare, a telehealth (or telemedicine visit, including MNT), requires both audio/visual components as how the service is provided, while the online assessment and management codes do not contain audio or visual components. CMS defines such services as "communication-based technology services" and so they do not fall under CMS' standard telehealth policies.

The online assessments and management services are meant to represent time spent on cases when an existing patient/client has reached out to the RDN to ask questions, through email or through online portals, etc. The general idea is that these questions are being answered/discussed to determine the need for an additional appointment for something like MNT (telehealth or in-person).

If the patient generates the initial inquiry within 7 days of an MNT encounter and the inquiry is related to the same problem, then the RDN cannot separately report these codes. CMS is temporarily relaxing enforcement of the restriction of use of these codes to established patients.

Answered April 3, 2020

What do all the current waivers and flexibilities around telehealth mean for Medicare Diabetes Prevention Program (MDPP) services?

For suppliers and beneficiaries enrolled in a Medicare Diabetes Prevention Program (MDPP) as of March 1, 2020, CMS is making the following temporary changes to MDPP:

  • The limit to the number of virtual make-up sessions is waived.
  • MDPP beneficiaries may receive a maximum of one session on the same day and a maximum of one virtual make-up session per week.
  • Virtual make-up sessions may only be furnished to achieve attendance goals and may not be furnished to achieve weight-loss goals.
  • An MDPP supplier may offer to an MDPP beneficiary no more than:
    • 15 virtual make-up session offered weekly during the core session period
    • 6 virtual make-up sessions offered monthly during the core maintenance session interval periods
    • 12 virtual make-up sessions offered monthly during the ongoing maintenance session interval periods
  • MDPP beneficiaries who were receiving services as of March 1, 2020 and have to pause services are permitted to obtain the set of MDPP services more than once per lifetime.
  • Virtual services must be furnished in a manner that is consistent with the CDC Diabetes Prevention Recognition Program (DPRP) standards for virtual sessions, follow the CDC-approved DPP curriculum requirements, and be provided upon the individual MDPP beneficiary's request.
  • The requirement for in-person attendance at the first core service remains in effect.

Answered April 3, 2020

Can MNT services be provided to Medicare Part B beneficiaries using the telephone?

No, MNT delivered via audio-only (telephonic visits) does not qualify for reimbursement under Medicare. Medicare requires audio-video connection for MNT (CPT® codes 97802-97804; G0270) and DSMT (G0108-9) services. RDNs should inquire with private payers and state Medicaid programs about the use of telephone to provide MNT, especially for patients who do not have access to the required technologies. Visit the Academy's webpage on telehealth.

Medicare will temporally reimburse RDNs for providing telephone assessment and management services (CPT codes 98966-98968). These calls can be with patients or family members and must be initiated by them and not be related to MNT services performed within the last 7 days. Medicare currently is not enforcing the requirement that these services be for established patients only. RDNs should inquire with private payers about coverage for these CPT codes. Please see the Academy's Payment section.

Updated April 3, 2020

If we are working in a Federally Qualified Health Center(FQHC), can we provide MNT to our patients via telehealth?

Yes, RDNs in all FQHC and Rural Health Centers can provide MNT to patients of their own health centers, and patients can be in their homes. The temporary changes (CMS waivers) and the CARES Act allow Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to temporarily act as distant site providers for Medicare telehealth services. Providers can deliver services from their home if they are working from home on behalf of the health center. CMS still needs to issue further guidance around how they will be implementing these changes.

Updated April 3, 2020

I work for a company that provides home health services. Can I provide my services via telehealth and will my company get paid for these services?

You should follow your home health company’s policies when providing your services. Home health services fall under the Medicare Part A benefit. The CMS waiver that expanded coverage for more services delivered via telehealth was for Medicare Part B services and providers. The recent additional flexibilities included in the CARES Act allows Home Health Agencies to provide more services to beneficiaries using telehealth, so long as it’s part of the patient’s plan of care. MNT services within the plan of care continue to not be separately billable services. To learn about how MNT might be able to be provided as a separately billable service to Medicare home health beneficiaries, see Example 2 on the Medicare MNT Practice Setting FAQs.

Updated April 3, 2020

I have heard that health care providers can use non-HIPAA complaint communications technologies, for example Skype or Zoom, during the epidemic. What is permitted?

RDN providers may temporarily use non-public-facing communications technologies that do not meet the usual HIPPA standards to see Medicare beneficiaries. The ability to use non-HIPAA compliant communication technologies with patients who have private insurance or Medicaid should be confirmed with those payers. Keep in mind you may still have state requirements to meet. For more information, see question #10 in FAQs from the Department of Health and Human Services Office of Civil Rights notification of Enforcement Discretion, applying to all HIPAA covered health providers providing telehealth services during the emergency.

Updated April 3, 2020

What is different about billing (claim form) when MNT is provided via telehealth?

Medicare: For claims submitted to Medicare using a CMS1500 form for services provided via telehealth during the current public health emergency, CMS recently updated its billing instructions. Per this recent update, you do not need to use Place of Service code 02. Continue to use the same Place of Service code you would use if the service had been provided in-person. Modifier 95 should be applied to claim lines that describe services furnished via telehealth (box 24D). Hospital outpatient departments billing on the UB-04 form should also continue to complete the claim form as they would for an in-person visit. The Academy continues to seek clear guidance from CMS as how services provided in a hospital outpatient clinic should be billed and how the current telehealth flexibilities apply in these settings.

Private Payers/Medicare Part C (Medicare Advantage)/Medicaid: Each payer determines their own rules. Get clarification individually from private payers and state Medicaid programs for how to submit claims for MNT provided via telehealth. Clarify the following:

  • Place of Service code, if other than 02, and/or
  • Use of any modifiers. For example, modifier 95 describes synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

Updated April 3, 2020

Can an accredited DSMT program that is a certified provider under Medicare Part B bill for DSMT (G0108, G0109) when the RDN is working from home or an off-site location?

DSMT (G0108, G0109) is on the list of Medicare approved telehealth services (when injection training is not applicable) and falls under the current CMS waiver. So, the DSMT program would be able to submit claims to CMS for DSMT services provided via telehealth to Medicare beneficiaries in their homes. The waiver also allows for providers to be located at an off-site location. Employees should follow their employers' policies regarding working from home.

Updated April 3, 2020

Any new updates about MNT and DSME coverage for FQHC's? I work in a FQHC, and we'd like some clarification.

While the CARES Act allows Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to temporarily act as distant site providers for Medicare telehealth service, CMS still needs to issue further guidance around how they will be implementing these changes, especially around billing and payment as the CARES Act indicates it will be paid under fee-for-service rather than the Prospective Payment System. The Academy is monitoring the situation and will share updates as soon as they are available. For Medicaid patients, you will need to refer to guidance issued by your state Medicaid program.

Answered April 3, 2020

For RDNs offering MNT telehealth appointments remotely from their residence, can the patient be billed under the RDN's clinic address?

Yes, RDNs should continue billing for services using their typical place of service/billing address, even if the services are being delivered via telehealth from the RDN's home.

Answered April 2, 2020

We are considering offering DM education via telehealth as our diabetes clinic is temporarily closed to patients currently. We are an accredited ADA program in a hospital based outpatient clinic. We have never offered MNT before. In order to be able to offer MNT , does each individual RD in our clinic have to have their own Medicare provider number ( we each have an NPI #) or could we file it as we do for the DSMES under our hospital's Medicare number?

The answer to the question depends on how your clinic bills Medicare for services. If your diabetes clinic is owned by the hospital and the RDNs are hospital employees, the clinic most likely bills using the UB-04 form and bills under the hospital's NPI. If that is the case, you would bill MNT in the same manner. While the hospital could require the RDNs to enroll as Medicare providers and reassign their benefits to the hospital, many choose to not do so and bill for their services, instead, under the hospital's NPI. The Academy recommends checking with your hospital billing department to determine if they bill for both professional services and facility fees for outpatient services as your hospital outpatient clinic may only be able to bill for a facility fee for DSMT and MNT services.

Answered March 30, 2020

Are RDNs and MNT Services included in the Centers for Medicare & Medicaid Services Waiver that allows Medicare Part B services to be provided via telehealth and under much broader conditions, including using communications technologies by patients in their homes?

RDN Medicare providers who provide medical nutrition therapy, or MNT, and other covered services under Medicare Part B are included in the new waiver.

Answered March 26, 2020

Is it true that RDNs may be able to get reimbursed/paid for MNT delivered via telehealth due to the COVID 19 public health emergency?

The Centers for Medicare & Medicaid Services, or CMS, has temporarily expanded coverage for Medicare Part B health care services, including MNT, provided via telehealth. Medicare usually covers services provided via telehealth in rural areas only. Many private payers have also modified their policies related to telehealth delivery and payment. For more information, visit the Academy' s Telehealth Quick Start Guide for RDNs.

Answered March 26, 2020

I' m an RDN who provides nutrition care in a hospital inpatient setting. Can I provide such care via telehealth during the current national emergency?

Based on procedures put in place by your hospital to prevent spread of the coronavirus, you may be asked to provide care to inpatients via phone from your hospital or home. You should follow your hospital' s policies and recognize that such care still cannot be billed as a separate service to Medicare Part B because it is not an outpatient service.

Answered March 26, 2020

If our state' s Governor makes an executive order that contradicts what CMS officially says, which order should we follow, in terms of our ability to see patients through telehealth?

An executive order by a governor does not impact Medicare guidelines. An executive order by a governor could, however, impact Medicaid payment policies. We are in the process of researching the various executive orders by governors as well as Medicaid state waivers to better understand what it means for RDNs.

Answered March 26, 2020

Can I provide pre-transplant nutrition interventions via telehealth? Most of the patients I work with do not have Medicare prior to transplant.

If the services are provided in the outpatient setting, the facility or RDN can check with each payer regarding payer policies for providing services via telehealth during this national emergency. Payment for the MNT would be dependent on individual patient benefits, coverage details, and payer billing policies.

Answered March 26, 2020

What HIPAA-compliant telehealth platforms are available for use by RDNs in private practice?

There are many options available, either as part of practice management platforms or as stand-alone products. RDNs can view product demos and ask colleagues for recommendations or feedback regarding use of specific products. Members can collaborate using the reimbursement online community and/or DPG listservs. A quick Google search will also yield useful results. RDNs can choose a vendor that provides assurances they will protect electronic protected health information, or ePHI, by signing a HIPAA business associate agreement, or BAA. Read this notification from the Department of Health and Human Services for some examples of technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA BAA with a covered entity.

Answered March 26, 2020

What consent and privacy notifications need to be provided to patients receiving services via telehealth during the COVID-19 national emergency?

There are at least three aspects related to consent and privacy:

1) Separate consent to receive services via telehealth
Patients/client consent/agreement to receive services via telehealth is required. Under usual circumstances, written consent must be obtained, and many telehealth platforms have features that enable notification and consent. In the context of COVID-19, verbal consent is acceptable. RDNs should document the date and time of the verbal consent in the patient record.

2) Advising patient of privacy risks with communications technologies that are not HIPAA compliant
If RDNs are using temporarily approved communications technologies that do not meet the usual standards for HIPAA compliance, the RDN must inform the patient of the potential risk and obtain the patient's approval to proceed. Providers are also required to minimize those risks.

"...Effectively immediately, the Health and Human Service Office for Civil Rights will temporarily waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday non-public-facing communications technologies during the emergency. RDNs may use popular applications that allow for video chats. RDNs should notify patients that these third-party applications potentially introduce privacy risks. It is recommended that all steps be taken to use available encryption and privacy modes when using the following applications..."

3) Notification and receipt/acknowledgement of HIPAA policy
Additional HIPAA privacy restrictions still apply, therefore it is recommended at this time to issue a Notice of Privacy Practices to clients, clearly noting any changes to the notice during the COVID-19 pandemic, and documenting the date of issue and date of patient acknowledgement/acceptance (writing and/or verbally). For more information about practicing and getting paid for telehealth, visit the Academy's telehealth section.

Answered March 26, 2020

What is the Medicare reimbursement rate for MNT provided via telehealth to Medicare Part B beneficiaries?

Medicare pays for MNT provided via telehealth at the same rate as in-person visits. See the Medicare physician fee schedule for more information.

Answered March 26, 2020

Do private payers pay for MNT and other services provided by telehealth at the same rate as in-person services?

Private payers, Medicare Part C (Medicare Advantage), and Medicaid may not pay for telehealth services, including MNT, at the same rate, depending on their policies and state telehealth payment parity laws. For private payers, check with provider services (not member customer service) for each payer for their billing policies and fee schedule. Contact your state Medicaid program for its fee schedule.

Answered March 26, 2020

What CPT codes should be used to submit claims for MNT provided via telehealth?

MNT provided via telehealth is still MNT. The CPT® codes used to submit claims to Medicare (and most private payers and Medicaid) for in-person visits are the same codes used for telehealth: 97802, 97803, 97804, G0270. For more information about CPT® and G codes for RDNs, visit the Payment pages on the Academy' s website.

Answered March 26, 2020

Some clients/patients are claiming that they do not have copayments for services provided via telehealth during this time. Does this apply to MNT?

Many private payers are waiving copayments for some, or all health care services delivered via telehealth during the COVID-19 health emergency. Contact private payers regarding policy changes. Check private payer websites for provider information and/or contact provider services representatives if further clarification regarding MNT/nutrition counseling is needed.

Answered March 26, 2020

 I have heard that RDNs can bill using Online Assessment and Management Services codes. Is that correct?

The new online assessment and management services codes are not MNT codes, but provide payment for electronic communications when the communication has been initiated by the patient following an MNT visit. These codes (G2061, G2062 and G2063) became available Jan 2020, are designed for established patients, and are payable under Medicare when requirements for using the codes are met. Check with private payers and your state Medicaid program to confirm adoption of and payment for the equivalent CPT codes (98970, 98971 and 98972). For more in-depth information, read the November 2019 issue of the MNT Provider.

Answered March 26, 2020

Can I provide weight management services that are required prior to bariatric surgery via telehealth?

Since there is no Medicare benefit for MNT for obesity, the question is addressed in the context of private payers or Medicaid. If RDNs are providing pre-surgical weight loss intervention prior to surgery in the outpatient setting, practices/RDNs can check with payers to see if exceptions have been made to telehealth policies as a result of COVID-19. Separate payment for MNT provided as pre-surgical weight management interventions would be dependent on individual patient benefits, coverage conditions, and payer policies regarding claims submissions.

Answered March 26, 2020

Does professional liability insurance cover services provided by telehealth?

Many professional liability insurance policies offer coverage regardless how the service is delivered. At its core, a professional liability policy is written to cover an RDN for allegations of failure to provide professional services. In general, telehealth is considered to be part of the definition of professional services and may therefore already be covered under an existing policy, unless specifically excluded under the terms of the policy. Because all insurance companies and policies are different, RDNs should check with their insurance provider to be sure their professional liability insurance covers telehealth services and inquire whether an added endorsement is needed to their policy for telehealth services. Additionally, RDNs should not assume professional liability coverage for telehealth delivered services is viable across state lines. (Keep in mind, RDNs must be licensed in the state(s) in which the patient is receiving services, where licensure is applicable, whether the service is provided face to face or via telehealth.) RDNs should also inquire if the policy extends to services provided outside of the RDN' s resident state. As telehealth adoption increases, new policies may be adopted. RDNs should review their liability coverage details annually. The professional liability insurance offered through the Academy's Member Advantage Program (Proliability administered by Mercer Consumer) does not exclude telehealth/telemedicine services.

Answered March 26, 2020

In the context of the inpatient setting, I have been restricted from going to the patient floors and have been told by my CNM that I can only do nutrition assessments on the telephone. Is this within my licensure to do telephone assessments?

In general, practitioners should look at their state licensure laws and regulations (some states may, for example, require that initial nutrition assessments or visits be face to face), as well as any notifications about requirements that may be temporarily suspended to accommodate service delivery during the pandemic response. If in doubt, reaching out to your state health department is recommended.

Answered March 25, 2020

I am an RDN who usually provides in-person counseling. Do you have any advice for those of us who must suddenly switch to telehealth?

The Academy has a quick guide and tip sheet available for members and provides guidance about practicing telehealth during the COVID-19 national public health emergency. The guide is for RDNs who are not working in facilities and who already provide in-person MNT to consumers with Medicare, commercial/private insurance, and/or Medicaid (e.g., already a network provider with payers).

Answered March 24, 2020

Food Security and Access

What should someone do if they are feeling sick but need groceries or resources?

If you or someone you provide care for is sick or has been diagnosed with COVID-19, the Centers for Disease Control and Prevention recommend staying at home, unless after speaking with your health care provider, you need to leave to get medical care. It is recommended that people who are experiencing symptoms avoid visiting public places and taking public transportation, rideshares or taxis. The CDC offers additional steps to help prevent the spread of COVID-19 if you are sick and how to care for yourself at home.

There is also detailed planning guidance from the CDC to help households prepare for an outbreak of COVID-19 in their community, including steps they can take both before and after an outbreak has occurred. Included below are just a few of the details:

  • Get to know your neighbors – neighborhood websites or social media pages may provide access to information and resources.
  • Identify aid organizations in your community – this may include resources to provide you with information, health care services, support, food or other supplies or services.
  • Create an emergency contact list for your household – including family, friends, health care providers, employers, local health departments and other community resources.
  • Stay in touch with others by phone or email - ask for assistance as needed, especially if you live alone or become sick.

When developing a plan for your household, you should base the details on the needs and daily routine of your household members. Local public health agencies also may make additional recommendations or have additional resources for their communities.

Answered April 3, 2020

Do we know how long COVID-19 can live on fresh fruits and vegetables? I am concerned about people washing their produce with soapy water and disinfectants.

While it is possible for the coronavirus to survive on some surfaces, there is currently no evidence to suggest that COVID-19 can be transmitted through food or food packaging. It is believed that the virus spreads from person-to-person through close contact or respiratory droplets.

Proper food safety practices should always be implemented while preparing foods. This includes frequently washing hands with soap and water and washing surfaces and utensils with hot soapy water after each use.

Fruits and vegetables, even if their peel will not be eaten, should be rinsed under running water and dried with a clean cloth or paper towel. It is recommended that firm produce, such as melons or cucumbers, be scrubbed with a clean produce brush. Soap, bleach or commercial cleaning products should never be used when washing fresh produce.

For more details on proper produce washing, watch our video.

Answered March 27, 2020

What recommendations are there for food delivery shipments at hospitals and long-term care facilities to help decrease the risk of COVID-19 transmission from vendors? Are there any recommendations for food service staff in these types of facilities to help reduce the spread of COVID-19?

There is currently no evidence to show food or food packaging as a means of transmission for COVID-19. It may be possible for viruses to survive on surfaces and objects, though, reinforcing the need to observe proper hygiene and food safety practices.

Hospitals and other facilities may limit access vendors and third parties have to their buildings during the current COVID-19 outbreak. Food suppliers that previously were able to deliver food indoors may be required to leave packages outside, and staff may be required to bring them inside to align with physical distancing measures. The Academy's Dietetic Practice Group, Dietetics in Health Care Communities, recently recorded a webinar on Front and Back of House Precautions for nutrition and dietetics practitioners working in these settings. Local and state health departments also may have guidelines established during this pandemic and should be consulted.

Regular handwashing, along with routine cleaning and disinfecting, especially all frequently touched surfaces, remain the most effective ways to reduce the spread of COVID-19 and are essential in any food service setting. Additional information regarding Food Safety and the Coronavirus Disease 2019 (COVID-19) is available on the U.S. Food and Drug Administration's website.

Answered March 26, 2020

I've noticed grocery stores running low on items, does this mean there is a food shortage?

According to the USDA, there are currently no food shortages. If grocery shelves are low in certain food items or supplies this is an issue with inventory or how much the store ordered based on what it expected to sell. A recent and unexpected increase in demand for groceries and non-food items has left many stores with little time to restock shelves.

FEMA is asking individuals to only buy enough groceries for one week. The United States Department of Agriculture and the U.S. Food and Drug Administration are closely monitoring the food supply chain for any shortages.

Answered March 24, 2020