Lucid Diagnostics Inc. Q1 FY2026 earnings call

• Balance Sheet and Capital Structure

  • Completed an underwritten public offering of common stock that generated ~$16.8 million in net proceeds, bringing pro forma cash to ~$45 million as of the end of Q1 2026, extending operating runway into 2027 and eliminating near-term financing pressure
  • Average quarterly cash burn over the past 4 quarters was $11.3 million, with Q1 2026 burn at $12.1 million due to targeted investments in commercial, sales, clinical services, and market access teams
  • Total GAAP operating expenses were flat year-over-year, with sales team cost increases offset by lower general and administrative expenses; non-GAAP net loss per share was $0.07, an improvement of $0.03 per share compared to the prior three quarters
  • Post-conversion of all preferred shares, there are approximately 203 million fully diluted common shares outstanding for EPS modeling
  • PAVmed remains the largest single shareholder with ~15% ownership and ~25% combined voting interest with the board and management

• Commercial and Clinical Progress

  • Maintained overall test volume above target during the pre-Medicare period, despite Q4 2025 having an unusual one-time boost from large firefighter testing events that inflated that quarter's volume
  • VA expansion efforts are progressing well: the company is on the federal supply schedule with a contracted $1,938 Medicare-rate payment, has built a robust national pipeline of VA center engagements, received its first purchase order, and expects to begin testing and generating VA revenue in the near term. EsoGuard's value proposition is uniquely strong for the VA system due to its higher-risk patient population, rural remote locations, and resource constraints for endoscopy procedures
  • The company is actively pursuing coverage with commercial payers that already explicitly list EsoGuard as an approved triage test in their existing endoscopy coverage policies, and has secured its first non-public coverage policy with a major laboratory benefit manager (LBM), which will be announced publicly in the coming weeks
  • Had a strong presence at the 2026 Digestive Disease Week (DDW) conference, where the American Gastroenterologic Association previewed updated draft Barrett's esophagus clinical guidelines that name EsoGuard/EsoCheck specifically and rate their clinical evidence as high certainty, a positive milestone for future coverage adoption
  • Ongoing clinical evidence development continues, including an active NIH study, institutional collaborative studies, and real-world evidence collection via a patient registry, independent of Medicare coverage efforts. The company is also evaluating long-term FDA engagement options following the courts' vacatur of the FDA LDT rule
  • EsoGuard already holds CE marking for international markets, but the company remains focused on the U.S. market with limited resources, and will only pursue international opportunities via partnering if they make strategic and financial sense without significant domestic resource diversion

Lucid Diagnostics operates only one core product segment, the EsoGuard esophageal cancer triage test. In Q1 2026, the company performed 3,177 EsoGuard tests, above the pre-Medicare target range of 2,500 to 3,000 tests. Total list price billable value was over $8.7 million, with $1.3 million in recognized revenue, holding average sale price steady. 13% of Q1 claims were from the government segment (predominantly Medicare and Medicare Advantage), down from 15% in Q4 2025 (a 2% difference equal to ~60 tests). Of the 77% of Q1 claims that have been adjudicated, 31% resulted in an allowable insurance payment, with an average of $1,646 per test, near the contracted Medicare rate of $1,938. Recognized revenue for Q1 included 72% from insurance claims submitted in prior quarters, consistent with the company's revenue recognition policy of recognizing revenue only upon cash collection for most unsettled claims.

• Management maintained its long-standing expectation of a positive Medicare local coverage determination (LCD) for EsoGuard, and stated that current delays are purely logistical backlog in the CMS MolDX process, not substantive concerns about the test's clinical or economic value
• The company plans to maintain its current quarterly cash burn rate at roughly recent levels (~$11-12 million per quarter). Any incremental investments to scale commercial operations after Medicare approval are expected to be largely offset by increased revenue from higher test volume and collections, so no large jump in burn is anticipated
• Management expects VA revenue and test volume contribution to grow throughout 2026 as purchase orders are secured and testing launches at additional centers, with no material contribution from VA in Q1 2026
• No meaningful increase in the percentage of Medicare patient volume is expected quarter-over-quarter before Medicare coverage is finalized, as the company balances maintaining overall test volume with pre-coverage positioning using existing resources
• The company will begin reporting covered lives for commercial payers after the first LBM coverage policy is publicized and participating plan policies are confirmed, which is expected in the near term

• Final Medicare LCD issuance has encountered extended logistical delays within the CMS process, creating uncertainty around the timing of coverage and associated revenue acceleration
• Most non-contracted insurance claims do not have sufficient consistent payment data to allow revenue recognition at the time of test delivery, creating volatility in reported revenue that does not reflect the total quarterly test volume
• Only 31% of adjudicated non-Medicare claims currently result in insurance payment, with most denials due to claims of not being medically necessary, investigational status, missing prior authorization, or additional required documentation
• The company has a 4.99% ownership blocker for certain preferred stock converted shares, which means ~22 million additional shares will be issued only if the blocker is adjusted or lifted in the future, creating potential future share count dilution
• International expansion opportunities face structural market challenges, particularly in European socialized health systems, where the economics for molecular screening tests are generally unfavorable

Q: What is the update on the timing and status of the MolDX Medicare LCD process for EsoGuard, given recent Medicare coverage activity in the diagnostic space?

A: Management continues to have ongoing dialogue with MolDX leadership, and confirms that no substantive concerns about EsoGuard have emerged. Delays are attributed to broader industry-wide LCD backlog, not issues with the application itself, and management remains highly confident that the backlog will clear soon and result in a positive coverage decision, anchored by the favorable public CAC meeting commentary from independent physician experts.

Q: What is the current status of VA expansion, including engagement structure, systems integration, and near-term revenue expectations?

A: Lucid is on the federal supply schedule with a contracted $1,938 Medicare payment rate, and is engaging VA centers on an individual basis with 2 dedicated national strategic leads and full participation from the existing sales team. The pipeline is robust, the first purchase order has been received, and testing will launch imminently at the first center, with no revenue contribution in Q1 2026. EHR integration is not a meaningful barrier for VA adoption, and EsoGuard's value proposition is uniquely strong for VA's high-risk, rural-leaning patient population. VA expansion is entirely independent of Medicare coverage. EsoGuard will be paid directly by the VA regardless of Medicare timing.

Q: Are commercial payers waiting for Medicare to issue coverage, or are some moving forward with coverage now? What is the current state of commercial payer engagement?

A: Most commercial payers are waiting for Medicare to act as a catalyst, but a subset of payers that already have endoscopy policies explicitly naming EsoGuard as an approved triage test are moving forward. Lucid is actively pursuing credentialing and contracting with these payers, and has already secured its first positive coverage policy with a large laboratory benefit manager, which will be made public in the next few weeks. Multiple additional positive coverage discussions are ongoing with other LBMs.

Q: What is the current share count for modeling, and what is the outlook for future cash burn after the recent capital raise?

A: The appropriate share count for EPS modeling is 203 million. The remaining ~22 million shares subject to the 4.99% ownership blocker will only be issued in the future when the blocker is adjusted, so they do not need to be included in current modeling. Current cash burn is expected to remain at roughly recent levels. Any incremental investments after Medicare coverage is obtained will be largely offset by increased revenue from higher test volume and collections, so no material increase in burn is projected.