CMS Releases WCMSA Statistics for Fiscal Years 2021-2025

December 3, 2025 / 4 min read

The Centers for Medicare and Medicaid Services (CMS) has released a document titled Workers’ Compensation Medicare Set-Aside (WCMSA) Fiscal Year Statistics: 2021-2025. This new CMS release follows the same format as the prior years and continues to provide high level basic information and statistics regarding various aspects of CMS’s WCMSA process reflecting, in part, the number of WCMSA recommendations issued by the WCRC and the total and average value of the proposed and recommended WCMSA amounts.

finger pointing to tablet

In reviewing this information, we noted several findings and recent trends. CMS reports that it reviewed approximately one thousand fewer WCMSAs in 2025 than in the prior year and CMS continues to propose higher approval amounts when compared against the submitted value. We also note that the average submitted anticipated settlement amount has trended back up after seeing a drop in 2024.

While it’s always challenging to understand these trends based on the limited information provided by CMS related to its WCMSA program, we note that several factors may have impacted the statistics:

Workers’ compensation claim volume continues to trend down, which would impact the number of settlements subject to WCMSA guidelines and submission.
Claim severity is increasing, which may be contributing to the higher submitted settlement amounts.
CMS sunset the review of zero MSA submissions in 7/17/2025 which helps to explain some of the reduction in the number of CMS reviewed WCMSAs in 2025.
The use of non-submission and EBMSAs to settle claims may be increasing.
The new 4/4/2025 Section 111 requirement to send WCMSA data as part of WC TPOC reporting provides CMS new visibility into the industry’s use of WCMSAs in all workers’ compensation settlements involving a Medicare beneficiary. Since the implementation of this new requirement, discrepancies in the reported WCMSA data and CMS’s WCMSA process have caused issues which CMS has yet to correct as discussed in our recent article. This may have had a chilling effect on the submission process as a result.

How Verisk can help

Medicare Secondary Payer compliance has experienced significant changes in 2025. In relation to WCMSAs, adjusting to CMS’s recent exclusion of zero MSAs from the WCMSA submission and approval process, and the new WCMSA reporting requirement have garnered the most attention.

In our experience, CMS’s decision to no longer accept submissions of zero MSAs has been met with mixed results. In many ways, this change would have been reasonably expected to streamline the settlement process for denied claims where the use of zero MSAs was most common. In fact, some users of zero MSAs have expressed to us that they actually valued knowing that CMS has reviewed and approved a zero MSA proposal, especially since CMS is collecting WCMSA data as part of WC TPOC reporting. Ultimately, it is solely up to the parties to determine if a zero MSA is appropriate and applicable and to document the file accordingly.

The requirement to submit WCMSA data with WC TPOC reporting has presented several challenges to Responsible Reporting Entities (RREs). With Section 111 civil monetary penalties currently live and CMS audits of Section 111 data starting in 2026, WCMSA reporting adds additional considerations and risk if the WCMSA data causes an error and rejection of the Section 111 TPOC record. Currently, if a record is rejected, the error must be corrected and successfully resubmitted within 1 year to avoid a fine. Best practice is to ensure the WCMSA data is not only accurate, but also, aligns with the WCMSA used in the settlement of the claim. Discrepancies may lead to CMS’s rejection of an approved MSA amount or unintended impact to a Medicare beneficiary’s access to their benefits. Finally, CMS has previously indicated in prior WCMSA webinars that it reserves the right to audit the values reported through Section 111 and may question reports of 0.00 and/or instances where an MSA exhausts prematurely.

We understand more than most the complexities, challenges, and needs related to Medicare Secondary Payor compliance, and we have developed several products and solutions in response to these changes to help our customers navigate these issues. Whether it’s our Data Driven MSA product to provide a WCMSA allocation for under-threshold claims, our MSA Link solution to drive corporate MSA compliance, or Data Sync to assist with accurately inputting and reporting the new WCMSA fields, we are thinking about the best way to solve for these issues, to improve workflows, and to empower excellence in today’s claims handlers.

Questions?

Please do not hesitate to contact the author if you have any questions, or to learn how Verisk can help you reduce WCMSA costs, evaluate zero MSAs, and navigate the new WCMSA/TPOC reporting requirements.