Summary of iRhythm Holdings, Inc. Q4 2025 Earnings Call

1Key Financial Results and Metrics

Q4 2025 Revenue: $208.9 million, a 27.1% increase year-over-year.

Full Year 2025 Revenue: $747.1 million, up 26.2% from 2024.

Gross Margin: Q4 gross margin at 70.9%, up 90 basis points YoY; full year gross margin at 70.6%, up 170 basis points YoY.

Operating Expenses: Q4 operating expenses were $145.8 million, up from $119.2 million YoY; full year operating expenses at $584.7 million, an 11.8% increase.

Net Income: Q4 net income of $5.6 million ($0.17 per diluted share), marking the first positive quarterly net income in company history; full year net loss of $44.6 million ($1.39 per diluted share).

Adjusted EBITDA: Q4 adjusted EBITDA of $34.3 million (16.4% of revenue), a 470 basis point improvement YoY; full year adjusted EBITDA at $68.9 million (9.2% of revenue), a significant increase from 2024.

Free Cash Flow: Generated $14.5 million in Q4 and $34.5 million for the full year, ending 2025 with $583.8 million in cash and equivalents.

2Strategic Updates and Business Highlights

Volume Growth: Continued strong volume-led growth across all channels, with 27% growth in Q4 marking the fifth consecutive quarter of over 20% revenue growth.

Market Position: iRhythm holds a 72% market share in long-term continuous monitoring, supported by over 135 scientific publications.

Primary Care Integration: Over one-third of volume now comes from primary care settings, with significant growth in integrated delivery networks and EHR-integrated workflows.

Predictive AI Advancements: Significant progress in AI capabilities, with early pilots showing over 85% accuracy in identifying patients at risk of arrhythmias.

International Expansion: Growth in the U.K., EU, and Japan, with plans for further scaling and evidence generation for reimbursement applications.

3Forward Guidance and Outlook

2026 Revenue Guidance: Expected in the range of $870 million to $880 million, representing 16% to 18% growth YoY.

Q1 2026 Revenue Guidance: Anticipated between $193 million and $195 million.

Gross Margin Improvement: Expected to improve by 80 to 100 basis points in 2026.

Adjusted EBITDA Margin Guidance: Projected to expand to 11.5% to 12.5% of revenue in 2026.

Free Cash Flow: Expected to grow compared to 2025, with a heavier weighting in the second half of the year.

4Bad News, Challenges, or Points of Concern

Regulatory Risks: Concerns regarding potential changes in Medicare reimbursement practices, particularly around chart-derived diagnoses and pricing pressures.

Market Competition: The competitive landscape is evolving, particularly with the rise of AI and other diagnostic technologies.

Operational Challenges: The need for ongoing investments in innovation while managing operating expenses and FDA remediation costs.

5Notable Q&A Insights

Chart Scraping Concerns: Management addressed concerns about the impact of CMS regulations on Zio use, emphasizing the product's ability to provide confirmatory diagnoses that could mitigate risks.

International Growth: International markets are expected to grow slightly faster than overall company growth, with ongoing efforts to establish a foothold in new regions.

Innovative Channel Partnerships: The innovative channel is seen as a growing segment, with expectations for continued expansion but with cautious guidance due to its emerging nature.

MCT Device Development: Management expressed confidence in the timeline for the next-generation MCT device, which is under FDA review, emphasizing the importance of cybersecurity enhancements in the new mobile gateway. Overall, iRhythm demonstrated strong financial performance in 2025, with a focus on strategic growth and innovation, while also addressing potential regulatory and competitive challenges as it moves into 2026.