CMS Maintains $750 Recovery Threshold for 2025

CMS is required to publish an annual threshold for recovery each year. This threshold amount reflects an amount for which CMS will not spend more on collections than a claim is likely to yield.

CMS announced that beginning January 1, 2025, the threshold for physical trauma-based liability insurance settlements will remain at $750. CMS will also maintain the $750 threshold for no-fault insurance and workers’ compensation settlements, where the no-fault insurer or workers’ compensation entity does not otherwise have ongoing responsibly for medicals.

This means that settlements of $750 or less do not need to be reported and Medicare’s conditional payment amount related to these cases does not need to be repaid.

Links to the alert and the threshold methodology are posted on the Non-Group Health Plan Recovery page of cms.gov.