Ten certificate 2026

1. Click ‘Get Form’ to open the ten certificate in the editor.
2. In Section A, select the appropriate certification type (Initial, Revised, or Recertification) and enter the corresponding dates.
3. Fill in the patient’s name, address, telephone number, and HIC number accurately.
4. Provide your supplier information including name, address, telephone number, and NSC or NPI number.
5. Indicate the place of service where the TENS unit will be used.
6. In Section B, list all relevant HCPCS codes for items ordered and complete patient details such as date of birth, height, weight, and sex.
7. Answer questions 1-6 regarding medical necessity by circling 'Y' for Yes or 'N' for No.
8. In Section C, provide a narrative description of equipment along with costs and Medicare fee schedule allowances.
9. Section D requires the physician's attestation; ensure they sign and date this section after reviewing all previous sections.

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