[1] The winners (Besa) and runners-up (Pelister) were promoted to the 2024–25 Macedonian First Football League.
The third-placed team (Detonit Plachkovica) qualified for the Macedonian First Football League play-off.
The bottom two teams (Teteks and Karaorman) were relegated to the 2024–25 Macedonian Third Football League.
The fourteenth-placed team (Pobeda) qualified for the Macedonian Second Football League play-off alongside the five group winners from the 2023–24 Macedonian Third Football League (Borec, Korabi Debar, Kumanovo, Vardarski, and Vëllazërimi J 1977).
The six teams were randomly drawn against each other for the final three places in the 2024–25 Macedonian Second Football League.