Florida’s 2025 Fee Schedule Changes Will Raise MSA Costs

Starting January 1, 2025, Florida is making some significant changes to its fee schedule, which will lead to higher MSA (Medicare Set-Aside) costs – sometimes significantly so. Here’s what you need to know.

Increased Physician Reimbursement Rates in Florida’s New Fee Schedule

In June 2024, the governor signed a new law that increases the maximum reimbursement rates for physicians and surgical procedures. For doctors, the rates will jump from 110% to 175% of the Medicare allowable reimbursement rate, while surgical procedures rates will rise from 140% to 210%. The Florida Association of Orthopaedic Executives said “that represents an unprecedented increase in physician reimbursement of 59% for non-surgical codes and 50% for surgical care.”  These rates haven’t changed in 20 years, and Florida is presently the lowest in the nation.

How Florida’s New Fee Schedule Affects MSA Pricing

What does this mean for MSAs? Since MSA pricing is based on the relevant workers’ compensation fee schedule, there is an opportunity to lock in lower costs for Florida MSAs if you get CMS approval before January 1, 2025.

What Should You Do?

• Already Have an MSA Prepared? If Tower has already prepared a Florida MSA for you and the estimated settlement exceeds CMS MSA review thresholds, submit it as soon as possible to achieve cost-savings.
• No MSA Yet, But Settlement Coming Soon? If you’re expecting a settlement in the coming months, now is the time to get an MSA prepared and submitted for approval.

Remember, once CMS approves an MSA, that approval does not expire.  So, even if settlement occurs after the fee changes, the approved MSA amount remains valid.

If you have any questions, feel free to reach out to Tower’s Chief Compliance Officer, Dan Anders, at daniel.anders@towermsa.com. And, if you’re ready to move forward with a Florida MSA submission or preparation, please contact us at referrals@towermsa.com.