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, driven by strong RNS System sales and favorable product mix.

• RNS System revenue reached $22.4M in Q4, up 26% year-over-year, with broad-based momentum in prescribers, accounts, and patient pipeline.

• Delivered second consecutive quarter of positive adjusted EBITDA and positive cash generation, demonstrating operating leverage and disciplined scaling.

• Submitted PMA supplement to FDA for expanded RNS indication in idiopathic generalized epilepsy (IGE), supported by strong NAUTILUS trial results.

• Advanced product pipeline with AI-enabled tools (Seizure ID/IDT), remote care capabilities, and next-generation neuromodulation platform.

Financial highlights

• Q4 2025 revenue grew 24% to $26.6M; RNS System revenue up 26% to $22.4M; service revenue $890K; DIXI Medical revenue $3M (down 4%).

• Q4 gross margin 77.4% (vs. 75.4% prior year); RNS gross margin 80.5%.

• Q4 operating expenses $22.3M (up 13%); loss from operations $1.8M (improved from $3.7M loss); net loss $2.7M (improved from $5.3M loss).

• Q4 adjusted EBITDA positive $900K; cash and equivalents $61.1M, up $1.1M sequentially; positive operating and free cash flow.

• Full-year 2025 gross margin 77.2% (vs. 72.9% in 2024); RNS gross margin 81.9%.

• Full-year adjusted EBITDA loss $5M, a $6.2M improvement year-over-year.

• Full-year net loss $21.5M, improved from $27.1M in 2024.

Outlook and guidance

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

• Q1 2026 revenue expected at $21M-$22M; full-year non-GAAP gross margin guidance 81.5%-82.5%.

• Full-year 2026 adjusted operating expenses expected at $90M-$92M; adjusted EBITDA loss of $9M-$10M.

• Anticipates front-loaded OpEx and more negative adjusted EBITDA in H1 2026, improving in H2.

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