Neuronetics (STIM) Q4 2025 earnings summary

Executive summary

• Achieved 23% adjusted pro forma revenue growth in Q4 2025, driven by strong capital shipments and Greenbrook clinic momentum; completed integration of Greenbrook, creating a vertically integrated mental health platform with national reach.

• Positive operating cash flow reached in Q4 2025, reflecting revenue growth, operational discipline, and improved cash collections.

• Announced leadership transition: Dan Reuvers appointed as next President and CEO, effective March 23, 2026.

• Operational focus on cost savings, cash flow improvement, and preparation for new treatment paradigms, including psychedelics.

Financial highlights

• Q4 2025 total revenue was $41.8 million, up 86% year-over-year as reported and 23% on an adjusted pro forma basis; full year 2025 revenue was $149.2 million, up 99% as reported and 15% pro forma.

• Gross margin for Q4 2025 was 52%, down from 66% prior year; full year 2025 gross margin was 48.5%, down from 72.3% in 2024, mainly due to Greenbrook's lower-margin clinic business.

• Net loss for Q4 2025 was $7.2 million ($0.10/share), improved from $12.7 million ($0.34/share) prior year; full year net loss was $39.1 million ($0.59/share), improved from $43.7 million ($1.38/share) in 2024.

• Cash and equivalents at year-end 2025 totaled $34.1 million, including $6 million restricted; positive operating cash flow of $0.9 million in Q4.

• Operating expenses for Q4 2025 were $26.7 million, up 1.4% year-over-year; full year operating expenses were $103.7 million, up 16.9%.

Outlook and guidance

• 2026 revenue guidance: $160–$166 million, representing 7%–11% year-over-year growth; Q1 2026 revenue projected at $33–$35 million.

• Full-year gross margin expected between 47% and 49%.

• Operating expenses for 2026 forecasted at $100–$105 million, including $8.5 million in non-cash stock-based compensation.

• Operating cash flow for 2026 projected between -$13 million and -$17 million, with positive cash flow expected in H2.

• Clinic business expected to grow double digits to mid-teens; NeuroStar business to grow low to mid-single digits.