Neuronetics, Inc. Q4 FY2025 earnings call

• Keith announced the board has appointed Dan Revers as the next president and CEO effective March 23rd. - Over the course of 2025, Greenbrook's full year clinic revenue grew 28% on an adjusted pro forma basis. The referring provider network added 430 new providers in Q4, a 25% year-over-year increase, with over 1,300 new referrers added across 2025. Regional teams completed over 47,000 physician outreach activities, driving over 2,300 patient referrals in Q4, a 46% increase year-over-year. Nearly complete with Spravato rollout, 84 clinics now provide the treatment. Total treatment volume up 18% year over year in Q4. Deployed tablet kiosks across all locations, piloting a patient portal, and leveraging AI in benefits investigation. - Neurostar business had a strong finish to the year, shipping 49 systems in Q4 at an average selling price above target for the fourth consecutive quarter. Treatment session revenue increased 6% in Q4 on a 11% strong treatment utilization growth. Better Me provider program had over 420 active sites at the end of 2025, connecting over 66,000 patients interested in Neurostar TMS with providers. TRICARE West expanded coverage for TMS therapy to include adolescents. The provider connection program launched in April 2025 has gained real traction, with over 400 educational meetings and over 210 new referral sites by year end. Leveraging Greenbrook infrastructure to offer new services like benefits investigations and patient management support to Neurostar customers.

In the fourth quarter of 2025, total revenue was $41.8 million, an increase of 86% compared to the fourth quarter of 2024, primarily due to the inclusion of Greenbrook operations. On an adjusted pro forma basis, fourth quarter revenue increased 23%. Total revenue from the Neurostar business, inclusive of system and treatment session revenue, was $18.3 million in Q4 2025, a 9% increase on a pro forma basis. U.S. Neurostar system revenue was $4.4 million, a 15% year-over-year pro forma increase, with 49 systems shipped. U.S. treatment session revenue was $12.4 million, a 6% pro forma increase. Clinic revenue was $23.5 million for Q4 2025, a 37% adjusted pro forma increase driven by growth in treatments across Neurostar TMS and Spravato treatments. Gross margin was 52% in Q4 2025 compared to 66% in the prior year quarter, due to the inclusion of Greenbrook's lower margin clinic business. Net loss for the quarter was $7.2 million, or $0.10 per share, compared to a net loss of $12.7 million, or $0.34 per share, in the prior year quarter. Fourth quarter 2025 EBITDA was negative $4.3 million, compared to negative $11 million in the prior year. As of December 31, 2025, total cash was $34.1 million. Cash provided by operations in the fourth quarter was a positive $0.9 million.

• For full year 2026, expect total revenue of between $160 and $166 million, with midpoint representing greater than 9% growth vs 2025. Clinic business expected to grow year-over-year in double digits to mid-teens. Neurostar business expected to drive revenue growth year-over-year in low to mid-single digits. - First quarter 2026 revenue projected between $33 and $35 million. - Full-year gross margin expected between 47% and 49%. - Operating expenses expected between $100 and $105 million for full year 2026, inclusive of approx $8.5 million of non-cash stock-based compensation. Operating expenses expected to be less than $100 million annualized run rate by Q4 2026. - Full-year 2026 cash flow operations expected between negative $13 million and negative $17 million. Operating cash burn expected highest in Q1 due to seasonality, then improve significantly in Q2 and sequentially through remainder of year, with positive operating cash flow during second half of year.

• Ongoing investigation by the U.S. Attorney Office and Middle District of Florida regarding billing practices prior to the acquisition of Greenbrook.

Q: Bill Plovonik asked about the CID investigation in Florida and Michigan related to Greenbrook's billing practices prior to acquisition.

A: It's an ongoing investigation, they are providing all information to the U.S. Attorney Office and cooperating fully.

Q: Bill Plovonik asked about Comp360's patient time in facility and profitability.

A: Corey Anderson stated Comp360 is administered in supervised doses in clinic setting, durable effect after one or two doses, and Steve mentioned working closely with Compass on reimbursement.

Q: Bill Plovonik asked about the $5 million paid down to Perceptive and cash position.

A: Steve said it doesn't come out of restricted cash, pro forma cash balance would be $29 million, comfortable with cash position as focused on efficiency and interest expense reduction.

Q: Adam Mader asked about clinic growth breakdown by Spravato and Neurostar volume vs capital.

A: Keith said clinic growth majority from volume, Q1 driven by Spravato B&B, Spravato was 30% of treatments at start of 2025 and 35% by year end, Neurostar has additional capital reps with expectation of more shipments.

Q: Adam Mader asked about Q1 guidance and trends.

A: Steve said seasonality impacts clinic (holiday impact in Q1) and Neurostar capital (lighter in Q1), also weather impacts.

Q: Danny Stauder asked about Compass collaboration exclusivity, integration into infrastructure, and Spravato rollout utilization.

A: Corey said Greenbrook is one of seven strategic collaborations with Compass, infrastructure largely in place for Comp360, and they are building up marketing presence for remaining Spravato locations to hit the ground running.