Core Insights - Neuronetics, Inc. has appointed Dan Reavers as the new President and CEO, effective March 23, indicating a leadership transition aimed at driving future growth [1] - The company reported strong fourth-quarter results with a 23% adjusted pro forma revenue growth, attributed to the successful integration of Greenbrook and increased treatment volumes [5][17] - Positive operating cash flow was achieved in Q4, marking a significant milestone for the company [6] Financial Performance - Total revenue for Q4 2025 was $41.8 million, an 86% increase from $22.5 million in Q4 2024, primarily due to the inclusion of Greenbrook operations [17] - NeuroStar business revenue was $18.3 million, reflecting a 9% pro forma increase year-over-year [17] - Gross margin decreased to 52% from 66% in the prior year, largely due to the lower margin of Greenbrook's clinic business [19] Operational Highlights - Clinic revenue grew 28% on an adjusted pro forma basis, with a significant increase in the referring provider network, adding 430 new providers in Q4 [6][12] - The company executed over 47,000 physician outreach activities, resulting in a 46% increase in patient referrals [7] - The rollout of SPRAVATO is nearly complete, with 84 clinics now offering the treatment [7] Strategic Initiatives - Neuronetics is focused on expanding its NeuroStar TMS systems market access through new models tailored to customer needs [26][27] - The company aims to address the unmet need for treatment-resistant depression (TRD) patients, with plans to advance collaboration with COMPASS Pathways on COMP360 psilocybin [28][29] - The infrastructure built for SPRAVATO is expected to facilitate the launch of new therapies, enhancing patient access and treatment options [30][31] Future Guidance - For 2026, total revenue is projected to be between $160 million and $166 million, indicating over 9% growth compared to 2025 [22] - The company anticipates strong growth in its clinic business, with double-digit year-over-year increases, while the NeuroStar business is expected to grow in the low to mid-single digits [22] - Operating expenses are expected to be between $100 million and $105 million, with a focus on efficiency improvements [23]

Financial Data and Key Metrics Changes - Total revenue for Q4 2025 was $41.8 million, an increase of 86% compared to $22.5 million in Q4 2024, primarily due to the inclusion of Greenbrook operations following the acquisition [17] - Adjusted pro forma revenue growth for Q4 was 23% year-over-year [17] - Gross margin decreased to 52% in Q4 2025 from 66% in the prior year, attributed to the lower margin of Greenbrook's clinic business [19] - Net loss for Q4 2025 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 [20] - Positive operating cash flow of $0.9 million in Q4 2025, marking a significant improvement from negative cash flow in previous quarters [21] Business Line Data and Key Metrics Changes - Clinic revenue grew 28% on an adjusted pro forma basis for the full year, with Q4 clinic revenue at $23.5 million, a 37% increase [6][18] - NeuroStar system revenue was $4.4 million in Q4, a 15% increase year-over-year, with 49 systems shipped [18] - Treatment session revenue for NeuroStar was $12.4 million in Q4, with a pro forma increase of 6% compared to the prior year [18] Market Data and Key Metrics Changes - The referring provider network added 430 new providers in Q4, a 25% increase year-over-year, contributing to over 1,300 new referrers added across 2025 [7] - Total treatment volume increased by 18% year-over-year in Q4 [8] - TRICARE West expanded coverage for TMS therapy to include adolescents aged 15 and older, effective across 26 states [12] Company Strategy and Development Direction - The company aims to leverage its integrated model to drive growth through expanding NeuroStar TMS systems to market and addressing the unmet need for treatment-resistant depression [25][26] - Collaboration with Compass Pathways on COMP360 psilocybin is seen as a potential transformational treatment for TRD, with plans for commercial launch upon FDA approval [27][29] - The company is focused on operational efficiencies and reducing overall expenses while driving towards sustainable operating cash flow [22][23] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's ability to continue improving cash flow and operational efficiency, with expectations for positive cash flow in the second half of 2026 [21][24] - The company anticipates strong revenue performance in its clinic business, with growth in the double digits to mid-teens, while NeuroStar business is expected to grow in the low to mid-single digits [22] Other Important Information - The company appointed Dan Reuvers as the new President and CEO, effective March 23, 2026 [5] - The company has made a one-time principal payment of $5 million to reduce outstanding debt obligations and interest expenses [21] Q&A Session Summary Question: Insights on CID investigation in Florida and Michigan - Management confirmed ongoing cooperation with the U.S. Attorney's Office regarding documentation for billing practices prior to the Greenbrook acquisition [35] Question: Differences in patient monitoring for COMP360 - The treatment effect of COMP360 appears durable after one or two administrations, similar to Spravato, and will require certified healthcare settings for administration [38] Question: Cash position and Q1 cash burn - The $5 million payment to Perceptive came from non-restricted cash, and the company remains comfortable with its cash position despite projected Q1 cash burn [41][42] Question: Guidance on clinic growth and Spravato contribution - Majority of growth in the clinic is expected to come from volume, with Spravato growth anticipated to be higher than TMS [46][47] Question: Integration of COMP360 into current infrastructure - The existing infrastructure for Spravato clinics provides advantages for administering COMP360, with experienced staff and back-office support already in place [64]

Financial Data and Key Metrics Changes - Total revenue in Q4 2025 was $41.8 million, an increase of 86% compared to $22.5 million in Q4 2024, primarily driven by the inclusion of Greenbrook operations following the acquisition [17] - Adjusted pro forma revenue growth for Q4 was 23% year-over-year [17] - Gross margin was 52% in Q4 2025, down from 66% in the prior year, due to the inclusion of Greenbrook's lower-margin clinic business [19] - Net loss for Q4 2025 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 [20] Business Line Data and Key Metrics Changes - Total revenue from the NeuroStar business was $18.3 million in Q4 2025, representing a 9% increase on a pro forma basis [17] - U.S. NeuroStar system revenue was $4.4 million, a 15% year-over-year increase, with 49 systems shipped in the quarter [18] - U.S. treatment session revenue was $12.4 million, with a 6% increase on a pro forma basis compared to the prior year [18] - Clinic revenue for Q4 was $23.5 million, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and Spravato [18] Market Data and Key Metrics Changes - The referring provider network added 430 new providers in Q4, a 25% increase year-over-year, contributing to over 1,300 new referrers added across 2025 [7] - Total treatment volume increased by 18% year-over-year in Q4 [8] - TRICARE West expanded coverage for TMS therapy to include adolescents aged 15 and older, effective across 26 states [12] Company Strategy and Development Direction - The company aims to leverage its integrated model to drive growth through expanding how NeuroStar TMS systems are brought to market and addressing the unmet need for treatment-resistant depression (TRD) [25][26] - Collaboration with Compass Pathways on COMP360 psilocybin is seen as a potential transformational treatment for TRD, with plans for commercial launch upon FDA approval [27][29] - The company is focused on operational efficiencies and expects to reduce operating expenses while driving revenue growth [22][23] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's ability to achieve positive operating cash flow and improve cash conversion through operational efficiencies [20][21] - The company anticipates strong revenue performance in 2026, with guidance for total revenue between $160 million and $166 million, representing over 9% growth versus 2025 [21][22] - Management acknowledged seasonality impacts on revenue, particularly in Q1, and noted weather-related challenges affecting patient access [51][54] Other Important Information - The company appointed Dan Reuvers as the new President and CEO, effective March 23, 2026 [5] - The company achieved positive operating cash flow in Q4 2025, marking a significant milestone [6] Q&A Session Summary Question: Insights on CID investigation in Florida and Michigan - Management confirmed ongoing cooperation with the U.S. Attorney's Office regarding documentation for billing practices prior to the Greenbrook acquisition [35] Question: Differences in patient monitoring for COMP360 - The Chief Technology Officer explained that COMP360 would be administered under a REMS protocol similar to Spravato, with durable treatment effects after one or two doses [38] Question: Cash position after debt payment - Management clarified that the $5 million payment to Perceptive came from non-restricted cash, leaving a comfortable cash balance for operations [41][42] Question: Guidance on clinic growth and Spravato - Management indicated that the majority of growth in the clinic business would come from volume, with Spravato expected to represent a growing share of treatment volume [46][47] Question: Integration of COMP360 into existing infrastructure - Management stated that the existing infrastructure and staff at Greenbrook clinics are well-prepared to administer COMP360 treatments [65]

Financial Data and Key Metrics Changes - Total revenue in Q4 2025 was $41.8 million, an increase of 86% compared to $22.5 million in Q4 2024, primarily driven by the inclusion of Greenbrook operations following the acquisition [17] - Adjusted pro forma revenue growth for Q4 was 23% year-over-year [17] - Net loss for Q4 2025 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 [20] - EBITDA for Q4 2025 was negative $4.3 million, an improvement from negative $11 million in the prior year [20] - Cash provided by operations in Q4 was positive $0.9 million, marking a significant improvement from negative cash flow earlier in the year [21] Business Line Data and Key Metrics Changes - NeuroStar business revenue, including system and treatment session revenue, was $18.3 million in Q4 2025, representing a 9% increase on a pro forma basis [17] - U.S. NeuroStar system revenue was $4.4 million, a 15% year-over-year increase, with 49 systems shipped in the quarter [18] - U.S. treatment session revenue was $12.4 million, with a pro forma increase of 6% compared to the prior year [18] - Clinic revenue for Q4 was $23.5 million, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and Spravato [18] Market Data and Key Metrics Changes - The referring provider network added 430 new providers in Q4, a 25% increase year-over-year, contributing to over 1,300 new referrers added across 2025 [7] - Total treatment volume increased by 18% year-over-year in Q4 [9] - The expansion of TRICARE West coverage for TMS therapy to include adolescents aged 15 and older is a significant development for military families [13] Company Strategy and Development Direction - The company aims to leverage its integrated model to drive growth through expanding how NeuroStar TMS systems are brought to market and addressing the unmet need for treatment-resistant depression (TRD) [26][28] - Collaboration with Compass Pathways on COMP360 psilocybin is seen as a potential transformational treatment for TRD, with plans for commercial launch upon FDA approval [28][29] - The company is focused on operational efficiency and expects to reduce operating expenses to less than $100 million by Q4 2026 [23] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's ability to drive revenue growth and achieve sustainable operating cash flow, with expectations for positive cash flow in the second half of 2026 [25] - The company acknowledges seasonality impacts on revenue, particularly in Q1, and is adapting its strategies accordingly [55][56] - Management highlighted the importance of maintaining strong relationships with primary care physicians and enhancing patient access to treatments [26] Other Important Information - The company appointed Dan Reuvers as the new President and CEO, effective March 23, 2026, indicating a leadership transition [5] - The company has made significant progress in integrating Greenbrook's operations, achieving positive operating cash flow and strengthening its balance sheet [16] Q&A Session Summary Question: Can you provide details on the CID investigation in Florida and Michigan? - Management confirmed that they are cooperating with the U.S. Attorney's Office regarding documentation for billing practices prior to the Greenbrook acquisition [36] Question: What are the profitability and patient monitoring differences for COMP360? - The treatment effect of COMP360 appears durable after one or two doses, and it will be administered under a REMS protocol similar to Spravato [40][42] Question: How did the $5 million payment to Perceptive affect cash position? - The payment did not come from restricted cash, and the company remains comfortable with its cash position despite projected Q1 cash burn [43][44] Question: Can you elaborate on the growth guidance for the clinic and standalone businesses? - Majority of growth in the clinic business is expected to come from volume, with Spravato growth anticipated to be significant in Q1 due to buy-and-bill impacts [50] Question: What are the integration requirements for the Compass collaboration? - The existing infrastructure for Spravato clinics will facilitate the integration of COMP360 treatments, with minimal additional updates needed [68]

Financial Data and Key Metrics Changes - Total revenue for Q3 2025 was $37.3 million, an increase of 101% compared to $18.5 million in Q3 2024, primarily driven by the inclusion of Greenbrook operations following the acquisition [16][19] - On an adjusted pro forma basis, revenue increased by 11% year-over-year [16] - Gross margin decreased to 45.9% from 75.6% in the prior year quarter, mainly due to the lower margin of Greenbrook's clinic business [18][19] - Net loss for Q3 2025 was $9.4 million or $0.13 per share, compared to a net loss of $13.3 million or $0.44 per share in the prior year [19] Business Line Data and Key Metrics Changes - Revenue from Greenbrook clinics was $21.8 million, up 25% on an adjusted pro forma basis compared to the prior year [6][18] - NeuroStar business revenue was $15.5 million, with system revenue at $3.5 million and treatment session revenue at $10.5 million [16][19] - NeuroStar treatment session utilization grew 11% year-over-year, indicating strong demand despite a decrease in treatment session revenue due to customer inventory adjustments [17][18] Market Data and Key Metrics Changes - SPRAVATO volumes increased sequentially in Q3 compared to Q2, with 84 of 89 eligible clinics now offering the therapy [8][18] - The company is optimizing its SPRAVATO offering by adjusting billing methods based on state and payer reimbursement dynamics [8][22] Company Strategy and Development Direction - The company is focused on integrating and optimizing operations post-Greenbrook acquisition, aiming to improve efficiencies and capture full value from combined businesses [5][15] - Strategic partnerships, such as with Elite DNA and Transformations Care Network, are expected to expand NeuroStar's footprint and enhance treatment access [23][24] - The company is committed to operational excellence and cash optimization, with initiatives like self-check-in kiosks and AI integration to improve patient experience and reduce costs [12][13][14] Management's Comments on Operating Environment and Future Outlook - Management expressed confidence in the company's ability to execute on priorities and create value for patients and shareholders, highlighting strong momentum in the Greenbrook integration and operational improvements [15][25] - The company anticipates achieving positive cash flow from operations in Q4 2025, with projected revenue guidance of $40 million to $43 million [20][22] Other Important Information - The company has received additional funding under its existing debt agreement, strengthening its cash position [20] - New York State Medicaid began covering NeuroStar TMS therapy for adults with major depressive disorder, expanding access to over 5 million members [15] Q&A Session Summary Question: What is driving the growth dynamics between Greenbrook and NeuroStar sites? - Management noted that Greenbrook clinics saw nearly 28% growth year-over-year, driven by SPRAVATO and TMS segments, while NeuroStar's treatment utilization increased but did not translate to revenue growth due to inventory adjustments [28][29] Question: What changed regarding gross margin expectations post-Greenbrook merger? - Management explained that the lower gross margin is due to the inclusion of Greenbrook's lower-margin clinic business, while NeuroStar's cost structure remains stable [30][31] Question: Can operational efficiencies be quantified in terms of cost savings? - Management indicated that while specific savings have not been quantified, investments in automation and technology are expected to drive long-term efficiencies [35][38] Question: How is the adolescent indication performing and what role does the provider connection program play? - Management reported an uptick in adolescent patient starts, largely driven by the provider connection network, which has increased awareness among primary care physicians [56][57]

Core Insights - Neuronetics, Inc. reported total revenue of $38.1 million for the second quarter of 2025, reflecting an 18% adjusted pro forma revenue growth and a 132% increase compared to the same quarter in 2024 [1][6][5] - The company achieved record revenue of $23.0 million from Greenbrook clinics during the quarter, contributing significantly to the overall revenue growth [1][6] - Cash used in operations was reduced to $3.5 million, outperforming the guidance of under $5 million [1][4] Financial Performance - Total revenues for the three months ended June 30, 2025, were $38.1 million, up from $16.5 million in the same period of 2024, primarily due to the acquisition of Greenbrook [5][6] - U.S. clinic revenue was $23.0 million, while international revenue increased by 41% to $452,000 [5][7] - Gross margin decreased to 46.6% from 74.0% year-over-year, mainly due to the inclusion of Greenbrook's clinic business [10] Operational Highlights - The company shipped 41 NeuroStar Advanced Therapy Systems, generating $3.5 million in revenue, although this represented a 13% decrease compared to the previous year [8][6] - U.S. treatment session revenue was $10.8 million, an 8% decrease year-over-year, but a 13% increase on a pro forma basis [9][6] - Neuronetics treated over 209,000 global patients with 7.6 million treatment sessions [6] Management and Strategic Developments - Steven Pfanstiel was appointed as the new Chief Financial Officer, bringing over 20 years of healthcare experience [16] - The company secured an additional $10 million in funding from Perceptive Advisors LLC, extending its liquidity requirements [14] - Neuronetics expects total worldwide revenue for the third quarter of 2025 to be between $37.0 million and $39.0 million, and for the full year 2025, between $149.0 million and $155.0 million [17][18] Future Outlook - The company anticipates gross margin improvement in the second half of 2025, expecting it to be between 48% and 50% [18] - Total operating expenses for 2025 are now projected to be between $100.0 million and $105.0 million, reflecting the integration of Greenbrook [19] - Neuronetics expects to achieve positive cash flow from operations in the fourth quarter of 2025 [20]