STIM — Neuronetics, Inc.

Summary of Neuronetics, Inc. Q4 2025 Earnings Call

1. Key Financial Results and Metrics

• Total Revenue: $41.8 million, an 86% increase from $22.5 million in Q4 2024, primarily due to the Greenbrook acquisition.
• Adjusted Pro Forma Revenue Growth: 23% year-over-year.
• NeuroStar Revenue: $18.3 million, a 9% increase on a pro forma basis.
• Gross Margin: 52%, down from 66% in Q4 2024, attributed to the lower margin of Greenbrook's clinic business.
• Operating Expenses: $26.7 million, a slight increase from $26.4 million in Q4 2024.
• Net Loss: $7.2 million ($0.10 per share), improved from a net loss of $12.7 million ($0.34 per share) in the prior year.
• EBITDA: Negative $4.3 million, improved from negative $11.0 million in Q4 2024.
• Cash Position: $34.1 million as of December 31, 2025, with $28.1 million in cash and cash equivalents after a $5 million debt repayment.

2. Strategic Updates and Business Highlights

• Leadership Transition: Dan Reavers appointed as the new CEO effective March 23, 2026.
• Greenbrook Integration: Successfully integrated Greenbrook, achieving a 28% increase in full-year clinic revenue on an adjusted pro forma basis.
• Provider Network Expansion: Added 430 new referring providers in Q4, contributing to over 1,300 new referrers in 2025.
• SPRAVATO Rollout: 84 clinics now offering SPRAVATO, with ongoing optimization of billing practices.
• NeuroStar Business: Strong demand for NeuroStar TMS, with 49 systems shipped in Q4 and a focus on higher-volume accounts.
• New Treatment Opportunities: Collaboration with COMPASS Pathways on COMP360 psilocybin, targeting treatment-resistant depression (TRD).

3. Forward Guidance and Outlook

• 2026 Revenue Guidance: Expected between $160 million and $166 million, representing over 9% growth from 2025.
• First Quarter 2026 Revenue Projection: Between $33 million and $35 million.
• Gross Margin Expectation: 47% to 49% for the full year 2026.
• Operating Expenses: Projected between $100 million and $105 million, with a goal of reducing to below $100 million by Q4 2026.
• Cash Flow from Operations: Expected to be negative $13 million to negative $17 million for 2026, with improvement anticipated in the second half of the year.

4. Bad News, Challenges, or Points of Concern

• Declining Gross Margin: The inclusion of Greenbrook's lower-margin operations has negatively impacted overall gross margins.
• Ongoing Investigation: An investigation by the U.S. Attorney's Office regarding billing practices prior to the Greenbrook acquisition, which could pose regulatory risks.
• Seasonality Effects: Q1 typically experiences lower patient volumes and capital revenues, impacting revenue projections.
• Cash Burn: Anticipated higher cash burn in Q1 due to seasonality and annual cash outlays, although improvements are expected later in the year.

5. Notable Q&A Insights

• Investigation Details: Management confirmed cooperation with the U.S. Attorney's Office regarding documentation requests related to billing practices.
• COMPASS Collaboration: Greenbrook is one of several strategic partners for COMPASS Pathways, with no exclusivity mentioned, but ongoing discussions for commercial readiness are expected.
• SPRAVATO Utilization: New clinics ramp up utilization quickly, with marketing efforts in place to ensure effective integration.
• Cash Position Clarification: The $5 million debt repayment did not come from restricted cash, and the company remains comfortable with its cash balance despite projected Q1 cash burn.

This summary encapsulates the key aspects of Neuronetics, Inc.'s Q4 2025 earnings call, highlighting financial performance, strategic initiatives, future outlook, and areas of concern.