CMS Releases 2025 WCMSA Fiscal Year Statistics; What the Numbers Tell Us

Just before Thanksgiving on November 26th, The Centers for Medicare & Medicaid Services’ (CMS) released its 2025 WCMSA (Workers’ Compensation Medicare Set-Aside Allocation) Fiscal Year Statistics.

Of note, the number of CMS-reviewed WCMSA submissions edged lower in the most recent fiscal snapshot, CMS’ recommended (Workers’ Compensation Review Contractor - WCRC) amounts remain meaningfully higher than submitters’ proposed figures (i.e., more “counter-high” outcomes). Vendor solutions that provide non-submit/indemnified MSAs, notably Sanderson Firm’s iMSA, are evidently gaining traction as submissions to the WCRC declined in this past year.

What the CMS Numbers Demonstrate

A few key measurable facts from CMS’ Fiscal Year statistics covering 2020–2025:

· Total WCMSA submissions completed continued to fall year over year again. Submissions fell from 14,862 in FY2024 to 13,884 in FY2025. That number had  previously dropped from 15,743 in FY2023 to 14,862 in FY2024.

· CMS’ recommended WCMSA total (the WCRC recommended amount) for FY2025 was about $1.196 billion with an average recommended WCMSA of $86,168.47, demonstrating a 24% average counter high on submitted WCMSAs.

Taken together, this demonstrates the fact that fewer formal submissions are completed by CMS, and the cases CMS does review often result in higher recommended allocations than submitters expected. That combination raises stakes for carriers, claim handlers, and counsel when structuring settlements and funding MSAs.

Why Submissions May Be Down and Why Counter-Highs are Up

Several regulatory and operational changes in 2024–2025 help explain these shifts:

· Policy & reporting changes. As of April 2025, CMS expanded Section 111 reporting for WCMSAs and increased visibility into settlements and MSA data, a move that makes WCMSA activity more transparent and shifts administrative requirements onto reporting parties. This kind of change can alter submission strategies and drive more careful pre-submission review by parties.

· $0 allocation policy change. CMS announced it would no longer accept or review zero-dollar WCMSA proposals effective July 17, 2025, which changes the calculus for settlements previously using a $0 MSA submission. That policy alone has pushed market participants to consider alternative compliance products and to document (or insure) zero allocations differently, such as Sanderson Firm’s indemnified zero iMSA.

· Stricter scrutiny and conservative recommendations. The rise in the percent change from proposed to recommended amounts suggests CMS is applying a conservative lens when protecting Medicare’s interests, resulting in more counter-highs. That creates incentive for submitters to either strengthen initial submissions or use alternatives (e.g., professionally prepared non-submit solutions or indemnified products) to reduce the risk of a materially higher CMS recommendation.

Where Sanderson Firm’s iMSA Fits In

Sanderson Firm has always been a proponent of the parties’ right to choose to participate in CMS’ voluntary WCMSA review process. Our iMSA product has been and remains incredibly popular for parties that prefer not to submit; instead, we reasonably recognize Medicare’s interests while protecting all the parties with our indemnification.

Why iMSA-Type Solutions are Catching On

· Indemnified MSAs offer risk transfer (indemnification against future Medicare claims) where CMS review is eliminated (e.g., zero proposals) or where submitters prefer to avoid the risk of counter-highs.

· They provide documentation and defensibility in a regulatory environment that now emphasizes reporting and beneficiary visibility.

· Our combined legal and clinical approach to iMSAs continue to gain popularity as stakeholders seek simpler, more certain settlement pathways.

Practical Takeaways for Claims Handlers, Defense Counsel, and Attorneys

· Don’t assume zero review equals zero risk. Even though CMS stopped reviewing $0 proposals after July 17, 2025, documentation, defensibility and Section 111 reporting remain essential — and our indemnified Zero iMSA market solution fills the governance gap.

· Budget for counter-highs. For settling parties who prefer CMS submission, be mindful of the persistent gap between proposed and recommended amounts (the FY2025 data shows a meaningful average increase). Plan settlements with a cushion for the anticipated increase.

· Consider indemnification when appropriate. Products like Sanderson’s iMSA are great solutions for the uncertainty created by these policy changes, especially where parties want to avoid CMS review or transfer future Medicare exposure.

Bottom line

The FY2020–FY2025 CMS statistics show fewer completed WCRC recommendations in the latest year but a persistent trend toward CMS significantly increasing the recommended MSA amount over what submitters propose. Coupled with CMS’ policy changes in 2025 (expanded reporting and the end of $0 reviews), the market is seeing stronger demand for vendor products that offer defensibility and risk transfer, and Sanderson Firm’s iMSA suite is a high-profile example of that market response.

If you have questions regarding the CMS’ NGHP User Guide update, $750 reporting threshold, or Sanderson Firm’s Section 111 reporting and audit solutions, please contact us.