Financial Data and Key Metrics Changes - Exagen reported Q3 2025 revenue of $17.2 million, the highest in its history, representing a nearly 40% increase over Q3 2024 and over 25% growth despite seasonal headwinds [16][24] - Year-to-date revenue grew 19% to approximately $50 million, with a trailing 12-month average selling price (ASP) up over 9% and volume up over 8% [16][24] - Gross margin for Q3 was just over 58%, up about 260 basis points compared to Q3 2024, but down about 175 basis points from just over 60% in 2024 [19][20] Business Line Data and Key Metrics Changes - Advise CTD testing volume reached the highest recorded for a third-quarter period, with a 15% increase from Q3 2024 and almost 2% sequentially [16][10] - The pharma services business generated nearly $800,000 in revenue for Q3, bringing the year-to-date total to $1.2 million, a significant increase from about $100,000 in 2024 [17][13] Market Data and Key Metrics Changes - The company expanded its sales territories from 42 to 45, with two new territories emerging as top-performing growth areas [11][10] - Total ordering physicians and orders per clinician continued to trend upward, indicating increased engagement from both new and existing physicians [11] Company Strategy and Development Direction - Exagen launched assays for the detection of Anti-PAD4 antibodies, enhancing its rheumatoid arthritis offering and demonstrating its ability to innovate in biomarker testing [5][9] - The company aims to achieve $65 million to $70 million in revenue for 2025, with a focus on becoming cash flow positive, although this may be pushed to 2026 due to ASP challenges [14][24] Management's Comments on Operating Environment and Future Outlook - Management acknowledged ASP growth has not ramped as quickly as anticipated, primarily due to the loss of a high ASP direct bill account and slower reimbursement for new biomarkers [12][18] - The company remains committed to driving ASP expansion through revenue cycle management and payer education, despite facing initial denials for new markers [49][72] Other Important Information - The company has a strong balance sheet with $35.7 million in cash and cash equivalents, up from $30 million at the end of Q2 [24][25] - Exagen's adjusted EBITDA loss improved to $1.9 million in Q3 2025, compared to $4 million in the same period last year [23] Q&A Session Summary Question: Updated revenue per territory for Q3 and productivity ramp of new territories - The revenue per territory was slightly below the previous record of $430,000 due to the addition of new territories, but growth is expected over time [27] Question: Incremental uplift to ASP from RA markers - The company has not established a payment history for the new RA markers yet, but expects a modest uplift compared to previous launches [28] Question: Updates on pharma partnership with urine platform - The first statement of work related to the urine platform has been completed, with ongoing discussions for subsequent efforts [29] Question: Approach to reaching $500 ASP target - The company believes the $500 ASP target is still realistic, but timing is uncertain due to recent challenges [32][34] Question: Impact of direct bill account loss on ASP - The loss of the direct bill account has primarily impacted ASP, but volume is trending positively as access to testing has been restored [67] Question: Higher denial rates for new markers - The increase in denials is primarily related to new markers, with insurers implementing more scrutiny [70][72] Question: ALJ hearing wins in Q3 - No notable ALJ hearing wins were disclosed, but the company continues to make progress in its appeals efforts [76]