New Hampshire Code of Administrative Rules
Agr - Commissioner, Department of Agriculture, Markets, and Food
Chapter Agr 2800 - ANIMAL POPULATION CONTROL
Part Agr 2803 - FORMS
Section Agr 2803.03 - Invoice of Sterilization Surgeries, Exams, and Immunizations

Universal Citation: NH Admin Rules Agr 2803.03

Current through Register No. 40, October 3, 2024

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

(b) An "Invoice" shall be:

(1) Completed by the participating veterinarian; and

(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.

(c) The participating veterinarian shall provide the following:

(1) Payee's name and address;

(2) That the payee certifies that this invoice is correct in all its particulars;

(3) Authorized payee signature, title, and date signed;

(4) Sterilization surgeries for the calendar month indicated;

(5) Number of female dogs receiving sterilization surgery or immunization in each of the Following weight categories:
a. Up to 25 lbs.;

b. 26-50 lbs.;

c. 51-75 lbs.; and

d. Over 75 lbs.;

(6) Number of female cats receiving sterilization surgery or immunization at any weight;

(7) Number of male dogs receiving sterilization surgery or immunization in each of the following weight categories:
a. Up to 25 lbs.;

b. 26-50 lbs.;

c. 51-75 lbs.; and

d. Over 75 lbs;

(8) Number of male cats receiving sterilization surgery or immunization at any weight; and

(9) Certification indicating that the participating veterinarian certifies that the above articles have been received or services rendered as stated herein; and

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

(1) Separately listing the amount of sterilization surgeries performed on dogs by sex and weight;

(2) Separately listing the amount of sterilization surgeries performed on cats, of any weight, by sex;

(3) Separately listing the unit cost of each sterilization surgery performed;

(4) Multiplying the number of sterilization surgeries by their respective unit cost to calculate the subtotals;

(5) Adding the subtotals to calculate the sterilization surgical total;

(6) Calculating 80 percent of the sterilization surgical total;

(7) Indicating total payment received from applicant and subtracting that total from the 80 percent sterilization surgical total;

(8) Adding the total immunization costs, not to exceed $15 per immunization, to the total determined from (7) above; and

(9) Adding the total examination fee.

(e) The invoice shall include a place for the administrator to sign and date that the administrator received the invoice from the participating veterinarian.

#5840, eff 6-17-94; ss by #6786, eff 7-1-98, EXPIRED: 7-1-06

New. #10568, eff 4-18-14

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