1. (a) Only numbered invoice pads provided to the participating veterinarian by the department shall be acceptable for reimbursement submissions.

2. (b) A “Monthly Invoice No.” shall be:

   1. (1) Completed by the participating veterinarian; and
   2. (2) Submitted to the program administrator within 10 days of the end of the month in which the sterilization surgery or immunization was performed under the program.

3. (c) The participating veterinarian shall provide the following:

   1. (1) Payee’s name and address;
   2. (2) That the payee certifies that the invoice is correct in all its particulars;
   3. (3) Authorized payee’s signature, title, and date signed;
   4. (4) Sterilization surgeries for the calendar month indicated;

   5. (5) Number of female dogs receiving sterilization surgery or immunization in each of the following weight categories:

      1. a. Up to 25 lbs.;
      2. b. 26-50 lbs.;
      3. c. 51-75 lbs.; and
      4. d. Over 75 lbs.;
   6. (6) Number of female cats receiving sterilization surgery or immunization at any weight;

   7. (7) Number of male dogs receiving sterilization surgery or immunization in each of the following weight categories:

      1. a. Up to 25 lbs.;
      2. b. 26-50 lbs.;
      3. c. 51-75 lbs.; and
      4. d. Over 75 lbs.; and
   8. (8) Number of male cats receiving sterilization surgery or immunization at any weight.

4. (d) Total reimbursement for the month indicated shall be determined by participating veterinarian:

   1. (1) Separately listing the amount of sterilization surgeries performed on dogs by sex and weight;
   2. (2) Separately listing the amount of sterilization surgeries performed on cats, of any weight, by sex;
   3. (3) Separately listing the unit cost of each sterilization surgery performed;
   4. (4) Multiplying the number of sterilization surgeries by their respective unit cost to calculate the subtotals;
   5. (5) Adding the subtotals to calculate the sterilization surgical total;
   6. (6) Indicating total payment received from applicant and subtracting that total from the sterilization surgical total;
   7. (7) Adding the total immunization costs, not to exceed $25 per immunization, to the total determined from (6) above; and
   8. (8) Adding the total examination fee.
5. (e) The administrator shall sign and date indicating that the invoice form was received from the participating veterinarian.

Source. #5840, eff 6-17-94; ss by #6786, eff 7-1-98, EXPIRED: 7-1-06 New. #10568, eff 4-18-14; ss by #14129, eff 11-26-24, EXPIRES: 11-26-34