SI-BONE, Inc. Q4 FY2025 earnings call

• Innovation-led growth: Built deep technical expertise, has a differentiated platform with 3 FDA breakthrough device-designated products. Secured favorable reimbursement. Proprietary technologies used in over 140,000 procedures worldwide. - 2025 milestones: Record revenue, over 2,400 U.S. physicians performed nearly 22,000 procedures, 22% increase in U.S. physicians using technologies, strengthened reimbursement position with NTAP and TPT, launched INTRA Ti, on track for third breakthrough device filing. - Physician engagement: Record 1,640 physicians performed procedures in Q4, 18% growth in physician adoption, double-digit growth across call points, physicians who performed procedures have high utilization potential. - Commercial execution: Ended Q4 with 89 quota-carrying territory managers, annual revenue per territory $2.1 million, 18% YOY growth, hybrid sales model with over 300 third-party agents, plan to add 10 new territories in 2026, strategic partnership with Smith & Nephew, leadership changes with new CCO and COO/CFO.

In 2025, SI-BONE generated record annual worldwide revenue of nearly $201 million, marking over 20% growth. Fourth quarter worldwide revenue was $56.3 million, up 15%. U.S. revenue in Q4 was $53.5 million, up 13.9%, with full-year U.S. revenue at $191.1 million, up 20.6%. International revenue in Q4 was $2.9 million, up 38.8%, and full-year international revenue was $9.8 million. Gross profit in Q4 was $44.5 million, up 14.8%, with full-year gross profit at $159.9 million, up 21%. Gross margin was 79% in Q4 and 79.6% for the full year. Adjusted EBITDA was positive $5.1 million in Q4 and $8.9 million for the full year. Free cash flow was positive in Q4 2025.

• 2026 worldwide revenue expected $228.5 million to $232.5 million, 14%-16% YOY growth, weighted towards second half. - 2026 annual gross margin expected ~78%. - Annual operating expenses expected to grow 12.5% at midpoint of revenue range. - Expect increased adjusted EBITDA compared to prior year and on track for free cash flow commitments. - Tailwinds include improved reimbursement, new product launches like INTRA Ti and third breakthrough device, commercial expansion, and partnership with Smith & Nephew.

Q: On the Smith & Nephew partnership, how did it come about and potential contribution?

A: Partnership with Smith & Nephew built on hybrid sales model experience, covers Level 1 and 2 trauma centers, allows trauma surgeons access to solutions, frees direct sales force to focus on other areas, too early to see full impact.

Q: Clinical data on IPM physicians and engagement?

A: STACI study shows efficacy of TORQ product used by interventionalists, INTRA Ti rounds out SI Joint Fusion portfolio for interventional physicians.

Q: Cadence on revenue and innovation super cycle?

A: Revenue growth back half weighted due to tailwinds materializing, innovation super cycle over next 5 years with regular product launches targeting new clinical adjacencies in spine and interventional.

Q: Guide upside and INTRA Ti in ASC?

A: Potential upside from procedure volume growth, ASP discipline, INTRA Ti ramp, and partnership evolution; current 35% of SI Joint Fusion sales in ASC, INTRA Ti expected to grow business in ASC.

Q: Commercial expansion and patent extension?

A: Strategically add territories by identifying opportunities, promoting or hiring, legacy Classic is less than 0.1% of business.

Q: Smith & Nephew partnership cadence and gross margin guidance?

A: Partnership starts seeing activity in March, ramps up, gross margin guidance 78% with noncash impact from surgical capacity and new products, but allows revenue acceleration and profitable dollar expansion.