NeuroPace (NPCE) Q4 2025 earnings summary

Executive summary

• Achieved Q4 2025 revenue of $26.6M, up 24% year-over-year, and full-year revenue of $100M, up 25% year-over-year.

• RNS System revenue grew 26% in Q4, driven by adoption in Level 4 centers, favorable product mix, and expanding community access.

• Delivered second consecutive quarter of positive adjusted EBITDA and positive cash generation; Q4 adjusted EBITDA was $0.9M, full-year adjusted EBITDA was $(5.0)M.

• Gross margin improved to 77.4% in Q4 and 77.2% for the year, reflecting manufacturing efficiencies and higher-margin product sales.

• Submitted PMA supplement to FDA for IGE indication and launched AI-driven clinical tools.

Financial highlights

• Q4 gross margin was 77.4%, up 200 bps year-over-year; RNS gross margin exceeded 80%.

• Q4 operating expenses were $22.3M, up 13% year-over-year, below revenue growth.

• Q4 net loss was $2.7M, improved from $5.3M prior year; full-year net loss was $21.5M, improved from $27.1M prior year.

• Ended Q4 with $61.1M in cash and equivalents; long-term borrowings at year-end were $58.9M.

• Full-year gross margin was 77.2%, up from 72.9% in 2024; RNS gross margin was 81.9%.

Outlook and guidance

• Reiterated 2026 revenue guidance of $98M–$100M, reflecting 20–22% RNS growth, excluding IGE and DIXI contributions.

• Q1 2026 revenue expected at $21M–$22M; full-year adjusted EBITDA loss projected at $9M–$10M.

• Non-GAAP gross margin for 2026 expected at 81.5%–82.5%; adjusted operating expenses at $90M–$92M.

• Expects IGE indication to contribute following potential NAUTILUS PMA-S approval in mid-2026.

• Commercial investments front-loaded in 2026, with productivity and leverage expected to increase in H2 and 2027.