On November 26, 2025, the Centers for Medicare & Medicaid Services (CMS) released the “Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics: 2020-2025,” available here.
By the Numbers
The one-page report is broken down into two tables. The first covers Workers’ Compensation Medicare Set Aside (MSA) proposed values, which are related to proposals voluntarily submitted to the Workers’ Compensation Review Contractor (WCRC). The WCRC is the CMS contractor that reviews and renders decisions on voluntarily submitted MSA proposals.
Table 1 includes FY statistics broken down by:
- Total WCRC Recommendations Completed (where a decision was rendered by the WCRC)
- Total Settlement Amount (aggregated settlement amounts associated with WCMSAs)
- Total Settlement Amount Average (the average settlement amount associated with a WCMSA)
- Total proposed WCMSA Amount (aggregated proposed WCMSA amounts – not the “recommended” or “approved” amount by CMS)
- Total Proposed WCMSA Average (the average amount of each proposed WCMSA – again, not the final “approved” amount by CMS)
The second table displays figures related to WCRC values, which are associated with the WCRC’s determination following voluntary MSA submission and the WCRC’s review and determination. In other words, this table contains amounts/figures related to what CMS indicates the MSA should be (i.e., the approved amount) vs. what the submitter initially proposed.
Table 2 includes FY statistics broken down by:
- Total WCRC Recommended WCMSA Amount (aggregated contractor determined WCMSA approved amounts)
- Total WCRC Recommended WCMSA Average (the average amount of each WCRC approved WCMSA)
- Percentage Proposed vs. Recommended Change (the % difference between the submitter’s proposed amount vs. the WCRC’s determined amount – i.e., “counter higher”)
- Recommended Medical Amount (WCRC determined aggregated amount associated with the healthcare services portion of WCMSAs)
- Recommend Medical Amount Average (the average WCRC determined amount for the healthcare portion of an individual WCMSA)
- Recommended Rx Amount (aggregate amounts associated with the prescription drug potion of WCMSAs as determined by the WCRC)
- Recommended Rx Amount Average (the average WCRC determined amount for the prescription drug portion of an individual WCMSA)
Highlights
CMS Decisions Decreased in FY2024 from FY2023
FY2025 saw a total of 13,884 decisions, which was roughly a 6.6% decrease from FY2024’s figure of 14,862. Overall, several factors may contribute to the slight decrease in decisions from FY2024, including the policy change as of July 17, 2025, whereby CMS no longer accepts zero-dollar proposals, stakeholder non-submit options or internal operational changes by the WCRC. See WCMSA Reference Guide, v4.4, Sec. 4.2, at pg. 7.
MSA Amounts
Initially submitted or proposed MSA amounts have remained relatively consistent over FYs 2021-2025, with an average over those five years being $70,643.27. The average proposed amount in FY2025 was $69,627.64 a slight decrease (-1.6 %) from FY2024’s corresponding figure, which was $70,775.58,
Recommended WCMSA amounts averaged $84,172.27 over a five-year period, with FY2025 having an average approved amount of $86,168.57, a small 0.28% increase over FY2024’s corresponding figure of $85,927.43
Total recommended amounts in FY2025 were $1.19 billion, down from $1.27 billion in the previous year, likely due in part to the decrease in recommendations completed. The total combined approved amounts from FY2021-2025 total approximately $6.15 Billion.
Counter-Highers
When the WCRC renders a decision on a WCMSA submission with a recommendation/approval for an amount higher than initially proposed, it is often referred to as a “counter higher.” See Sec. 9.4.4 in the WCMSA Reference Guide, v.4.4., at pg. 22.
The percentage difference between the initially proposed WCMSA amount versus the CMS approved amount increased from FY2024 to FY2025 (21% to 24%). It is notable this figure averaged 14% from FY 2021 – FY 2022 and saw a jump in FY2023 to 22%.
Reasons for this may be tied to changes in the methodology by the contractor, and/or allocation techniques and tactics utilized by submitters. See Chart 2 below for the differences over time.
WCMSA Average Amounts for Medical & Rx
A breakdown of the proposed medical and Rx amounts is not provided in the report. The approved average medical amounts remain flat from the previous year – however, Rx amounts have been trending down over the last five years while medical amounts have been increasing over the same time period.
MSA Figures in Proportion to Settlement Amounts
The average proposed settlement amount over FYs2021-2025 is approximately $160k with an average proposed settlement amount in FY2025 of $161.251.19, a 5.75% increase from FY2024’s figure of $152.487.15. The portion of the total recommended MSA amount to the total settlement amount average in FY 2025 is 53%.
In summary, we appreciate the agency’s efforts in sharing valuable insights from the Medicare Secondary Payer (MSP) program, particularly regarding MSAs. This data empowers stakeholders and compliance professionals to make informed decisions, refine their compliance strategies, and proactively prepare for future changes.
At Ametros, we continuously monitor these trends to identify best practices in professional administration and ensure that settlement parties receive the support they need.
