Neuronetics Q1 2026 Earnings Call Summary

1Key Financial Results and Metrics

Total Revenue: $34.5 million, up 8% from $32 million in Q1 2025.

NeuroStar Revenue: $12.9 million, down 3% year-over-year.

System Revenue: $3.2 million, up 13% (34 systems shipped, +10% YoY).

Treatment Session Revenue: $9.1 million, down 5% (3.5% increase in utilization).

U.S. Clinic Revenue: $21.5 million, up 15% YoY, driven by strong SPRAVATO growth.

Gross Margin: 46.9%, down from 49.2% YoY, impacted by revenue mix and SPRAVATO buy-and-bill.

Operating Expenses: $25.1 million, down 6% from $26.8 million in Q1 2025.

Net Loss: $10.8 million ($0.16 per share), improved from a loss of $12.7 million ($0.21 per share) YoY.

Adjusted EBITDA: Negative $6.6 million, improved by $2 million YoY.

Cash Position: $19 million as of March 31, down from $34.1 million at year-end 2025.

2Strategic Updates and Business Highlights

Leadership Transition: Dan Reuvers joined as CEO, emphasizing a focus on operational efficiency and patient impact.

NeuroStar Business: Plans to broaden market reach and enhance customer support through new commercial models.

Greenbrook Clinics: Revenue growth attributed to SPRAVATO and improved operational efficiencies; focus on workflow and revenue cycle management.

Cost Structure Alignment: Initiatives expected to yield annualized savings of $2.5 million to $3 million starting Q3 2026.

Potential for Psilocybin Therapy: Positive regulatory developments could position Greenbrook as a key provider if approved.

3Forward Guidance and Outlook

Revenue Guidance: Expected between $160 million and $166 million for the year.

Gross Margin: Projected between 47% and 49%.

Operating Expenses: Anticipated in the range of $100 million to $105 million.

Cash Flow: Expected operational cash flow to improve in Q2 and remain flat to positive in the second half of 2026.

4Bad News, Challenges, or Points of Concern

Declining NeuroStar Treatment Revenue: Decrease attributed to reduced customer inventory levels despite increased utilization.

Weather Impact: Adverse weather conditions affected TMS volumes, particularly in the Northeast, leading to lower patient flow early in the quarter.

Cash Burn: Concerns regarding cash reserves, with $19 million on hand and projected operational cash burn of $15 million for the year.

CFO Transition: Departure of CFO Steve Fansteel raises concerns about continuity in financial leadership.

5Notable Q&A Insights

Greenbrook Performance: CEO confirmed TMS volumes were below prior year levels due to weather disruptions but expected normalization in Q2.

Team Stability: Reuvers reported no significant turnover concerns and noted a strong connection to the company’s mission among employees.

Strategic Review: The CEO is evaluating the business with an open mind regarding potential separation of the NeuroStar and Greenbrook businesses, acknowledging shareholder concerns.

TMS Coverage Expansion: Recent changes allowing nurse practitioners to deliver TMS could expand the target market, although it remains early to assess impact.

Commercial Strategy: Emphasis on balancing utilization growth with expanding the installed base of NeuroStar systems, with ongoing pilots to refine go-to-market strategies. Overall, Neuronetics is navigating a transitional phase under new leadership, focusing on operational improvements and strategic growth while addressing challenges in revenue generation and cash flow management.