Neuronetics Q4 2025 Earnings Report

Neuronetics EPS Results

• Actual EPS: -$0.10
• Consensus EPS: -$0.12
• Beat/Miss: Beat by +$0.02
• One Year Ago EPS: N/A

Neuronetics Revenue Results

• Actual Revenue: $41.78 million
• Expected Revenue: $40.84 million
• Beat/Miss: Beat by +$933.00 thousand
• YoY Revenue Growth: N/A

Neuronetics Announcement Details

• Quarter: Q4 2025
• Date: 3/17/2026
• Time: Before Market Opens
• Conference Call Date: Tuesday, March 17, 2026
• Conference Call Time: 8:30AM ET

Neuronetics (NASDAQ:STIM) is a commercial‐stage medical technology company that develops and markets non-invasive neuromodulation therapies for psychiatric and neurological disorders. The company’s flagship product, the NeuroStar Advanced Therapy System, uses repetitive transcranial magnetic stimulation (rTMS) to deliver targeted magnetic pulses to areas of the brain implicated in major depressive disorder (MDD). NeuroStar Advanced Therapy has received U.S. Food and Drug Administration clearance for the treatment of adults with treatment-resistant depression and is supported by a growing body of clinical evidence demonstrating its safety and efficacy.

Founded in 2003 and headquartered in Malvern, Pennsylvania, Neuronetics focuses on advancing clinical care through innovation in neurostimulation. The company’s platform is designed for use in outpatient clinics, hospitals and psychiatry practices across the United States. Neuronetics maintains a specialized field sales force and collaborates with key channel partners to support physician training, patient education and therapy delivery. In addition to its commercial activities, the company continues to explore new indications and protocol optimizations to expand its therapeutic offerings.

Guided by a leadership team with deep experience in medical devices and neuroscience, Neuronetics strives to improve patient outcomes through research, regulatory engagement and post-market data collection. The company’s ongoing efforts include refining device features, enhancing treatment compliance and evaluating the use of its technology in other neuropsychiatric conditions. Neuronetics is publicly traded on the Nasdaq under the symbol STIM.

Neuronetics Q4 2025 Earnings Call Transcript

Key Takeaways

• Positive Sentiment: Board named Dan Reuvers as new CEO effective March 23, bringing 30+ years of medical-device leadership that management says will help scale the business.
• Positive Sentiment: Q4 adjusted pro forma revenue grew ~23% with total revenue of $41.8M and the company achieved positive operating cash flow in Q4, improving operating cash burn from -$17M in Q1 to +$0.9M in Q4.
• Negative Sentiment: Full-year 2026 guidance targets $160–$166M revenue (midpoint >9% growth) but forecasts operating cash flow of -$13M to -$17M with the first quarter being the weakest, so near-term cash burn is expected to continue.
• Positive Sentiment: Greenbrook clinic momentum continues—clinic revenue and referrals rose materially, Spravato is deployed in 84 clinics, and the company is positioning its network to roll out COMP360 (psilocybin) commercially if approved, which could expand future treatment offerings.
• Negative Sentiment: The company disclosed an ongoing civil investigative demand from the U.S. Attorney’s Office in the Middle District of Florida seeking billing documents for pre-acquisition Greenbrook practices and is cooperating, representing a legal/regulatory risk.

Presentation

[Operator]

Ladies and gentlemen, thank you for standing by, and welcome to the Neuronetics Reports Q4 2025 Financial and Operating Results. At this time, all participants are in a listen-only mode. After the speaker's presentation, there will be a Q&A session. To ask a question during this session, you would need to press star one one on your telephone. You will then hear an automated message advising your hand is raised. To withdraw your question, please press star one one again. Please be advised that today's conference is being recorded. I would now like to turn the conference over to Mark Klausner. Sir, please go ahead.

[Mark Klausner, Managing Partner at ICR Westwicke]

Good morning, and thank you for joining us for the Neuronetics Q4 2025 conference call. Joining me on today's call are Neuronetics President and Chief Executive Officer, Keith Sullivan, and Steve Pfanstiel, Neuronetics Chief Financial Officer. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the Greenbrook integration, and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

[Mark Klausner, Managing Partner at ICR Westwicke]

For a discussion of risks and uncertainties associated with Neuronetics business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's annual report on Form 10-K, which was filed pre-market today. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. During the call, we'll also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information, taken in conjunction with U.S. GAAP financial measures, provide useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results. Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans, to benchmark our performance externally against competitors, and for certain compensation decisions.

[Mark Klausner, Managing Partner at ICR Westwicke]

Reconciliation between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it's my pleasure to turn the call over to Neuronetics President and Chief Executive Officer, Keith Sullivan.

[Keith Sullivan, President, and CEO at Neuronetics]

Thanks, Mark. Good morning, everyone, and thank you for joining us today. Before I get into our results, I'm pleased to announce that the board has appointed Dan Reuvers as our next President and Chief Executive Officer of Neuronetics, effective March 23. Dan is a proven leader with more than 30 years in medical devices, and he knows how to build and scale commercial healthcare businesses. Having spent time with Dan through the search process, I am confident he is the right person to lead the company into the next chapter, and I'm looking forward to working with him to ensure a smooth transition. Now turning to our performance.

[Keith Sullivan, President, and CEO at Neuronetics]

A little over a year ago, we closed the Greenbrook acquisition and set out to build a vertically integrated mental health company with the technology, the clinical infrastructure, and the scale to fundamentally change how patients access treatment for mental health conditions. I'm proud to say that in our first full year as a combined company, we've done exactly that. We delivered a strong Q4 results with adjusted pro forma revenue growth of 23%, driven by our strongest capital shipment quarter of the year and continued momentum across our Greenbrook clinic network. We also achieved the key milestone of positive operating cash flow in the Q4, driven by revenue growth, operational discipline, and the cash collection improvements that we have been implementing throughout the year. Starting with the update on Greenbrook.

[Keith Sullivan, President, and CEO at Neuronetics]

Over the course of 2025, we executed against our growth initiatives, and the results speak for themselves. Full-year clinic revenue grew 28% on an adjusted pro forma basis. Our regional account manager program is building awareness among referring providers and helping more patients find relief from their depression in our clinics. In the Q4 , our referring provider network added 430 new providers, a 25% increase year-over-year, contributing to over 1,300 new referrers added across 2025. This growth was supported by significantly higher field engagement, with our regional teams completing more than 47,000 physician outreach activities during the year. These efforts drove over 2,300 patient referrals in Q4, representing a 46% increase over the prior year period.

[Keith Sullivan, President, and CEO at Neuronetics]

Our automated patient transfer process, educational tools, scheduling QR codes, and coordinated intake team engage patients while they are still at the primary care doctor's office. These capabilities are improving referral to treatment conversion while reducing friction for both the provider and the patient across the Greenbrook network. We are nearly complete with our Spravato rollout, with 84 clinics now providing the treatment. Throughout 2025, we optimized our billing practices based on the economics of buy and bill versus administer and observe. We have taken a disciplined approach to deploying the right billing model by state, by payer, and by clinic. Our efforts across both Spravato and TMS continue to drive strong results, with total treatment volume up 18% year-over-year in the Q4.

[Keith Sullivan, President, and CEO at Neuronetics]

On the operational side, we continue to drive standardization across the network, focused on getting patients into treatment faster and simplifying their experience at our clinics. We deployed tablet kiosks across all locations, streamlining check-in and making it simple for a patient to remit their patient responsibility payments at the time of the visit. We're also piloting a patient portal that allows patients to complete intake forms and submit insurance information before their appointment, with the goal of offering an all-digital intake pathway in the future. We are starting to leverage AI in our benefits investigation process. With initial application helping us file claims faster and more accurately, increasing first pass acceptance rates while reducing labor. Collectively, these efforts are enabling our team to care for more patients daily while improving our cash conversion. Turning to our NeuroStar business and the BMP program.

[Keith Sullivan, President, and CEO at Neuronetics]

On the system side, we had a strong finish to the year, shipping 49 systems in the quarter at an average selling price above our target for the fourth consecutive quarter. That tells us customers continue to see the value in NeuroStar and then in the support that comes with it. As we have discussed throughout the year, we made a deliberate decision to realign our capital team towards higher volume, higher growth accounts that could add NeuroStar TMS into their practices quickly. Meaning that they have the staff available to incorporate TMS into their practice, are credentialed with insurance payers, and therefore, can get up and running, treating patients faster.

[Keith Sullivan, President, and CEO at Neuronetics]

With that focus on TMS-ready accounts, we are seeing the benefits in system ASP, a reduction in resources needed to go from purchase to treatment of the first patient, and in the quality of accounts we are adding to the network. We believe this positions our NeuroStar business well heading into 2026, and I'll discuss more about that shortly. On a pro forma basis, treatment session revenue increased 6% in Q4 on a strong treatment utilization growth of 11%. Our BetterMe provider program had over 420 active sites at the end of 2025, with nearly 100 additional sites working towards qualification. Since inception, the program has connected more than 66,000 patients interested in NeuroStar TMS with one of our BetterMe providers. BMP sites continue to deliver significantly higher patient volumes and faster response times than non-participating sites.

[Keith Sullivan, President, and CEO at Neuronetics]

We have observed that treatment session utilization is increasing at these sites, indicating strong patient flow and demand for existing equipment. We also continue to see growing recognition of NeuroStar TMS as a treatment option for adolescents. During the quarter, TRICARE West expanded coverage for TMS therapy to include adolescent age 15 and older diagnosed with depression, and the coverage is effective across 26 states. That's a meaningful development for military families and further validates the expanding insurance landscape for adolescent TMS treatment. Moving on to our provider connection program, which we launched last April. The program has gained real traction. Our field team has held over 400 educational meetings, resulting in more than 210 new referral sites by year-end. We have also seen strong engagement through the directed provider campaigns and the inside sales outreach efforts.

[Keith Sullivan, President, and CEO at Neuronetics]

This program takes what we have learned at Greenbrook about educating primary care physicians on the benefits of NeuroStar TMS and applying it across our entire NeuroStar customer base, and it is becoming a meaningful part of how we help patients find and access care with NeuroStar providers. We are also leveraging our Greenbrook infrastructure to offer new services to our NeuroStar customers. Through our intake center, we are now providing benefits investigations and patient management support to partners like Transformations Care Network and Elite DNA. Our benefits investigation model delivers financial clarity to patients within 24 hours, helping practices accelerate patient decision-making.

[Keith Sullivan, President, and CEO at Neuronetics]

Our patient management program guides patients from initial interest through to treatment, ensuring seamless engagement at every step. These programs are already driving new patient starts at our partner sites and represent a scalable model that we can extend across our national enterprise accounts.

[Keith Sullivan, President, and CEO at Neuronetics]

Stepping back, I want to put this year into context. When we announced the Greenbrook acquisition, we laid out a thesis that combining NeuroStar's technology platform and training programs with the Greenbrook's national care delivery network, we would expand patient access, accelerate growth, and create a path to profitability. One year in, that thesis is playing out. We grew revenue, we reached positive operating cash flow, we strengthened our balance sheet, and we built a platform that is now enabling opportunities that neither company could have pursued on its own. I'll now turn it over to Steve to take you through the financial details, and then I'll come back to talk about what those opportunities look like heading into 2026.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Thank you, Keith, and good morning, everyone. Unless otherwise noted, all performance comparisons are being made for the Q4 of 2025 versus the Q4 of 2024. Total revenue in the Q4 was $41.8 million, an increase of 86% compared to revenue of $22.5 million in the Q4 of 2024, primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, Q4 revenue increased 23% versus the prior year. Total revenue from our NeuroStar business, inclusive of our system revenue as well as treatment session revenue, was $18.3 million in the Q4 of 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents an increase of 9% versus the prior year.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

U.S. NeuroStar system revenue was $4.4 million, an increase of 15% on a year-over-year pro forma basis, and we shipped 49 systems in the quarter. This compares favorably to our Q4 2024 shipments of 46 units, and we continue to see strong system ASP in the quarter. U.S. treatment session revenue was $12.4 million. On a pro forma basis, treatment session revenue increased 6% compared to the prior year quarter. The reported decline of 4% is primarily attributable to the absence of prior year Greenbrook intercompany purchases. Clinic revenue was $23.5 million for the three months ended December 31, 2025, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and Spravato treatments.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Gross margin was 52% in the Q4 of 2025 compared to 66% in the prior year quarter. The decrease was due to the inclusion of Greenbrook's clinic business, which operates at a lower margin. It's worth noting that Q4 gross margin was our highest quarterly margin of the year, reflecting the impact of our efficiency efforts within the Greenbrook clinics as well as favorable product mix. Operating expenses during the quarter were $26.7 million, an increase of $0.4 million, or approximately 1.4% compared to $26.4 million in the Q4 of 2024. The increase was primarily attributable to the inclusion of Greenbrook's general and administration expenses of $8.5 million, partially offset by a reduction of R&D expenses. During the quarter, we incurred approximately $2.2 million of non-cash stock-based compensation expense.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Net loss for the quarter was $7.2 million, or $0.10 per share, as compared to a net loss of $12.7 million, or $0.34 per share in the prior year quarter. Q4 2025 EBITDA was negative $4.3 million as compared to negative $11 million in the prior year. Moving to the balance sheet and cash flow. As of December 31, 2025, total cash was $34.1 million, consisting of cash and cash equivalents of $28.1 million and restricted cash of $6 million. This compares to total cash of $19.5 million as of December 31, 2024. Cash provided by operations in the Q4 was a positive $0.9 million, representing a continuation of the steady improvement we delivered throughout 2025.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

To put this in context, our operating cash burn improved sequentially every quarter this year from negative $17 million in Q1 to positive $0.9 million in Q4. This progress reflects the compounding effect of our continued revenue growth, expense discipline, revenue cycle management improvements, and operational efficiencies across the business. In March 2026, we amended our debt agreement with Perceptive, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a one-time principal payment of $5 million to Perceptive, along with adjustments to the existing covenants. Now turning to guidance. For the full year 2026, we expect total revenue of between $160 million and $166 million, with the midpoint of that range representing greater than 9% growth versus 2025.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

We expect to see strong revenue performance in our clinic business, with growth year over year in the double digits to mid-teens. For the NeuroStar business, we see increased momentum driving revenue growth year over year in the low to mid-single digits. For the Q1 2026, we project revenue of between $33 and $35 million. We expect full year gross margin to be between 47% and 49%. This reflects the impact of efficiency efforts within our clinic network as well as product mix associated with higher clinic revenue growth. As we drive revenue growth, we remain highly focused on operating efficiency. We expect operating expenses of between $100 and $105 million for the full year, inclusive of approximately $8.5 million of non-cash stock-based compensation. This total includes investments and costs associated with efficiency efforts primarily in the first half of 2026.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

We expect to see the full benefit of these efforts by the end of the Q3, with operating expenses at an annualized run rate of less than $100 million by the Q4 2026. For the full year 2026, we expect cash flow from operations to be between -$13 million and -$17 million. This includes the necessary investments in efficiency, particularly in the H1 of 2026, to continue our efforts to drive towards sustainable operating cash flow. Similar to last year, we expect our operating cash burn will be highest in the Q1 due to seasonality of both businesses, where we typically see our lowest patient volumes and lowest capital revenues. Additionally, the first Q1 is when we see higher annual cash outlays such as licenses and incentive compensation.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Operating cash flow is projected to improve significantly beginning in the Q2 and then sequentially through the remainder of the year, with operating cash flow being positive during the H2 of the year. I will now turn it back to Keith for his closing remarks.

[Keith Sullivan, President, and CEO at Neuronetics]

Thank you, Steve. I would now like to spend a few minutes on multiple meaningful opportunities ahead of us in 2026. We have spent the last year proving that our integrated model works. We now have a national platform with over 420 BMP accounts and Greenbrook locations across 49 states. A proven playbook for launching therapies in clinic-based settings, deep relationships with primary care physicians, and an infrastructure that gets stronger with every patient we treat. As we move into 2026, we are focused on leveraging that platform to drive the next phase of growth through two key initiatives. First, we are expanding how we bring NeuroStar TMS systems to market. As we continue to analyze the TMS market, we have determined that different customers want to acquire access to our technology in different ways.

[Keith Sullivan, President, and CEO at Neuronetics]

We are piloting new models to meet these customers' needs, allowing them to utilize NeuroStar TMS in a way that works best for them. We are testing these approaches during the Q1 and will provide updates throughout the year on their progress. We have expanded our capital sales team to help target and capture these opportunities. Second, we will continue to see strong growth in demand for depression treatment at our Greenbrook clinics. We now know that a significant unmet need remains. There are approximately 4 million patients with treatment-resistant depression, or TRD, in the United States, and individuals who have failed 2 or more antidepressants and have limited effective options. NeuroStar TMS and Spravato are both important therapies for many of these patients, but the vast majority of TRD population remains undertreated, and we believe new therapy options can help us reach more of these patients.

[Keith Sullivan, President, and CEO at Neuronetics]

That is why we're excited to continue to advance our collaboration with Compass Pathways on COMP360 psilocybin, a potentially transformational new treatment for TRD. We believe that this could represent one of the most meaningful developments in mental health treatments in decades. Compass has recently completed 2 phase 3 studies demonstrating highly statistically significant and clinically meaningful results, including durable improvement through at least 26 weeks after just 1 or 2 doses. Compass plans to submit an NDA with the potential for an FDA decision by year-end. Our Greenbrook clinics are uniquely positioned to be the leader in offering new therapies like this. We already serve a large TRD population across our network, and we believe a new FDA-approved option has the potential to drive increased awareness and engagement from both patients and referring providers.

[Keith Sullivan, President, and CEO at Neuronetics]

Through our experience integrating and scaling Spravato across the Greenbrook network, we have built a proven playbook for launching REMS compliant therapies, those requiring enhanced safety protocols and administration in the clinic-based settings. We have a national footprint, experienced staff, and an operational infrastructure to support a launch. Because of the alignment with our existing Spravato operations, we expect only limited incremental investment to support this new modality if approved. Through our existing collaboration with Compass, we are preparing to commercially offer this treatment upon an FDA approval. We have identified the initial centers for the rollout, and we are working closely with Compass to align launch plans and to support the establishment of favorable coverage policies with payers. We see this as a natural extension of what we have built, further expanding Greenbrook's care platform to deliver innovative treatments to patients who need the most.

[Keith Sullivan, President, and CEO at Neuronetics]

Beyond treatment-resistant depression, we are also excited about the broader promise of psychedelic class treatments, which have the potential to help patients suffering from PTSD, generalized anxiety disorder, and other serious conditions. We want Greenbrook to be the platform that can serve all these patients, and our track record of launching and scaling treatments across a national clinic network gives us confidence that we can deliver on that vision. We are excited to share more as we get closer to the potential launch in 2027. Before we open for questions, I want to take a moment to reflect on my time at Neuronetics. When I joined over five years ago, we were a single product company with a bold vision.

[Keith Sullivan, President, and CEO at Neuronetics]

Today, we are a vertically integrated mental health platform with a national clinic network, a growing base of committed NeuroStar providers, and a pipeline of potential new treatment modalities on the horizon. None of that happens without this team. The people at Neuronetics and across the Greenbrook clinics show up every day with a commitment to patients. I'm proud of what we have built together, and I'm proud of the difference we are making in the lives of patients and providers across the country. I leave this company in a position of strength and in very capable hands with Dan. I believe the best is truly ahead for Neuronetics. With that, I'd like to turn the call over to the operator for questions.

[Operator]

Thank you. As a reminder to ask a question, please press star one one on your telephone and wait for your name to be announced. To withdraw your question, please press star one one again. Our first question is gonna come from Bill Plovanic with Canaccord. Your line is now open.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

Hey, great. Thanks. Good morning, and thanks for taking my question. First of all, Keith, congratulations on your retirement on a significant transformation of a business. I think this was $50-ish million in revenues when you took over five years ago and just adding Greenbrook and the scale and finally hitting that target of cash flow positive. You know, it's definitely a hard-fought battle, but won, and congratulations.

[Keith Sullivan, President, and CEO at Neuronetics]

Thanks, Bill. I appreciate it.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

I have three questions, one of them simple. Just, you know, one, I'm gonna start with the tough one. Just any granularity color you can provide on the CID in Florida and Michigan and what documents they're really asking for, and is this related to Greenbrook?

[Keith Sullivan, President, and CEO at Neuronetics]

William Plovanic, that is an investigation that is ongoing at the moment. What we can say about it is that we are providing all of the information to the U.S. Attorney's Office in the Middle District of Florida. They've requested documentation for billing practices prior to our acquisition of Greenbrook, and we're cooperating fully with them.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

Okay. Thank you. Just secondly, on the Spravato, thanks for the update. You know, on the COMP360, just if you could give us any feeling for difference in time the patients have to be in the facility post treatment or delivery of medication. You know, any difference in the profitability, like, is this gonna be shorter and more profitable, or the patient hangs out longer and it's less profitable per hour, per minute, whatever metric you look at? How do we think about that as that rolls out?

[Keith Sullivan, President, and CEO at Neuronetics]

Bill, we have asked, Cory Anderson, who is our Chief Technology Officer and running the Greenbrook side of the business, to join us today. I'm gonna let him answer that question for you.

[Cory Anderson, CTO at Neuronetics]

Yeah, good morning, Bill, and thank you for the question. Comp360 is administered in supervised doses within the clinic setting. There's not a daily or recurring protocol. Unlike these daily medications, the treatment effect appears to be durable after just one or two administrations. If it's approved, Comp360 would be administered under a REMS protocol requiring certified healthcare settings, trained staff and patient monitoring, very similar to what we're currently doing with Spravato.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

And then-

[Keith Sullivan, President, and CEO at Neuronetics]

Go ahead.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Yeah, Bill, this is Steve. Just to add, you asked about the economics. I mean, we're working closely with Compass to you know look at reimbursement and understand that as we get closer to launch. More to come on that piece, but I would view it similar to how we've looked at Spravato A and O and Spravato B and B. You know, if the reimbursement is there, it's a great business, but we're not gonna take on business that isn't gonna be profitable at the end of the day. I think Compass is working hard, and we're working hand in hand with them to make sure we've got adequate reimbursement to make this a profitable business.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

Great. Last question, Steve, is, you know, you ended the year with $34.1 million. $6 million was restricted. Now you paid down $5 million to Perceptive. Did that $5 million come out of the restricted cash or the non-restricted cash? And how do you feel about the cash position given the projected Q1 cash burn?

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Yeah. It does not come out of the restricted piece. You know, if you looked at the end of 2025, we had $34 million. If you take kind of that five million off, it would be pro forma cash balance of $29 million. If you look at the midpoint of our operating cash flow guidance, you know, we would still have, you know, call it $14 million-$15 million of cash at year-end. Obviously, some of that being restricted, but that's a cash balance that we've been comfortable with, especially as we're focused on efficiency, reducing overall expenses and profitability, especially in the second half of this year.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

I think the other benefit of paying that down is just we get interest expense reduction from that. It's probably gonna save us close to $600,000 annually just for that $5 million pay down. It just kind of optimizes that overall debt balance that we have out there. Net net, we're comfortable with where we sit, and I think it continues kind of reducing that operating cash flow burn by taking out some interest.

[William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity]

Great. Thanks for taking my questions.

[Operator]

Thank you. Our next question is going to come from Adam Maeder with Piper Sandler. Your line is open.

[Adam Maeder, Managing Director, Equity Research at Piper Sandler]

Hi, good morning, Keith and Steve. Keith, wishing you all the best in the next chapter. A couple of questions from me. You know, I guess wanted to start on the guidance front and just double-click on the 7%-11% top-line guidance for the overall business. If I heard correctly, double digits to mid-teens growth for the clinic, low to mid-single-digit growth for standalone. Can you just help us understand within the clinic how much is coming from Spravato? On the NeuroStar or standalone side of things, volume versus capital, and then I had a couple of follow-ups. Thanks.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Yeah. Thanks, Adam. I'll give a little bit of commentary on that. On the clinic side, we expect, you know, majority of the growth to come from the volume side of it. Although in Q1, in particular, we will have a lot of Spravato growth due to BNB. As you recall, we really didn't have buy-and-bill volume in 2024, and it was actually pretty limited in Q1 of this past year. In fact, you know, we kind of stabilized more in Q2 of last year at about one out of every seven Spravato treatments being buy-and-bill. Prior to that, in Q1, it was still very limited. I think what you'll see on the growth is Q1 driven by that Spravato BNB impact. Once we get into Q2, it's annualizing.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

From that point forward, really it's about just volume growth overall. Spravato growth, I think, will be volume growth will be higher than TMS in general, but we haven't broken out that growth rate. Maybe just to give you a flavor, Spravato was probably 30% of our treatments at the start of 2025. It was about 35% by year-end 2025. I would expect to see kind of that pattern continue of Spravato representing kind of more of that treatment volume on a quarter-over-quarter basis throughout 2026. It's just a significant growth. I think the thing to remember about Spravato in particular is, once you start a patient and they respond, they stay on maintenance therapy long term, whereas with TMS, it's a course of 36 treatments.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

They're done, and they'll come back, you know, only if they need to. It's a little different cadence of how those patients build over time, but Spravato certainly we have that continuing maintenance therapy that patients stay on, you know, long term. On the NeuroStar side, give a little bit of color there. Keith mentioned that we do have additional capital reps. We've been generally at around 40 capital shipments a quarter, a little less in Q1, a little higher in Q4. We would expect that to increase, you know, to as much as 45 or more, as their impact is felt over time. I think it'll take a little bit of time for those reps to get up and running.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

You know, the guidance we gave, really because our treatment session is just the biggest segment of the business, we would expect kind of growth there to largely match the overall guidance of what we gave for the NeuroStar side of the business growth.

[Adam Maeder, Managing Director, Equity Research at Piper Sandler]

That's great color. Appreciate that, Steve. You know, for the follow-up, actually wanted to ask about Q1 guidance and, you know, Street was a little bit higher than where you've guided to for the Q1, maybe some mismodeling on our part. You know, can you just talk about the trends in the business quarter to date? You know, are you seeing anything that, you know, has maybe deviated from past trends? Just, yeah, would love some incremental color for kind of the first couple months of the year. Thanks.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

Yeah. I'll give a couple comments there. Certainly one is, you know, we're still just over a year into the Greenbrook acquisition. A big piece of kind of what we've come to understand is just there's just seasonality in the business itself. We find kind of, call it, latter half of November and December, we just see new starts come down on the clinic side of the business. That's just holiday impact. That kind of works its way through the first part of Q1 here. We tend to have a little bit of that negative seasonality impacting us in Q1.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

I think if you look, it's not uncommon for us to see a huge swing between Q1 and Q4, between the overall level of revenue, and clinic seasonality is a big piece of that. I would say seasonality also impacts us on the NeuroStar side of the business, especially when you think about capital. Capital is just always lighter in Q1 versus Q4. That has to do with just how capital budgets are planned in clinics and at our customers. Generally, they're kind of using it in Q4, and using less of it in Q1. You know, depending on how you look at that, those are two big seasonality impacts.

[Steven Pfanstiel, EVP, CFO, and Treasurer at Neuronetics]

I think the other thing that's, you know, really been an impact here, especially over the last, call it two months, we've certainly had some weather impacts, which affects the impact of, you know, patients being able to get in the clinic. We're gonna have some of that every winter, but that's obviously something we have to manage as well as we think about, you know, January, February, March, and some of the storms we've had. That bleeds into the seasonality that we generally see as we go from Q1, which again, we've said is kind of our always our lowest revenue quarter of the year to then to Q4, which is generally the highest.

[Adam Maeder, Managing Director, Equity Research at Piper Sandler]

That's helpful. Thanks. I'll jump back in the queue.

[Operator]

Thank you. Our final question is gonna come from Daniel Stauder with Citizens JMP. Your line is now open.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Yeah, great. Thanks for the questions. Just first off, Keith, congratulations on a great run. It's been great working with you.

[Keith Sullivan, President, and CEO at Neuronetics]

Yeah, same.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Sending my congrats and just reiterating everyone else's comments. I guess first on the Compass collaboration, you know, that's really positive news. I know we've talked a bit about this new wave of therapeutics and the potential role Neuronetics could play here, but I was hoping you could give us any more color on this agreement specifically. It sounds like you'll be the preferred provider, but is there any exclusivity involved at this point? If not, could there be in the future? Thanks.

[Keith Sullivan, President, and CEO at Neuronetics]

Cory?

[Cory Anderson, CTO at Neuronetics]

Yeah. Thanks for the question. You know, Greenbrook has been working with Compass over the past three years, and we have continued to advance that collaboration to begin or help them with their preparations for commercial launch. We anticipate through the course of this year we will have continued discussions about our preparations as an organization to launch the therapy. As you probably are aware, our CMO, Dr. Geoff Grammer, participated in a Compass-hosted webinar in January. We have you know laid out our operating plans to be prepared for the launch next year. As to the point of exclusivity, Compass has about seven of these strategic co-collaborations to help them prepare for commercial readiness, and Greenbrook is one of them.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Great. Appreciate. Just following up on that, staying with Compass, you know, it sounds like there shouldn't be too much more of a lift, but, you know, beyond having to update some of your workflow maybe, are there any other updates you need to make such as personnel or anything physical to your clinics? Really just trying to get more of an appreciation of how seamlessly this could integrate into the current infrastructure you have.

[Cory Anderson, CTO at Neuronetics]

Yes.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Thank you.

[Cory Anderson, CTO at Neuronetics]

Yeah. You know, as you are aware, we operate about 84 Spravato clinics under this REMS framework across the country. I think our infrastructure and experience in running these Spravato clinics provides three key advantages for Greenbrook. First, our staff, our clinical staff is experienced in both administering and monitoring these patients under treatment. Second, we have a significant infrastructure and investment in the back office support of benefits investigations, prior authorizations, and ultimately helping patients access care. Then third, we have a deep network of referring providers, psychiatrists, primary care doctors and others that refer their patients to Greenbrook for these treatments.

[Cory Anderson, CTO at Neuronetics]

I think the infrastructure is largely there and, you know, we will be able to provide COMP360 treatments within the clinics and with the staff already in place at Greenbrook.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Appreciate that. Just one final one for me on the Spravato rollout. Sounds like you are nearly complete with all the 89 sites, but just wanted to ask on the utilization of Spravato for these newer converted clinics. You know, how quickly has this ramped in once it's available? Is it weeks, months, quarters? Just trying to get a sense of some of these utilization trends. Thank you.

[Keith Sullivan, President, and CEO at Neuronetics]

We look at our utilization, our marketing, and our conversion rates on a daily basis. We are able to identify where we need to add Spravato and where we don't. In the five locations that are remaining, we are building up that marketing presence there to be able to hit the ground running. We are very comfortable with each one of our locations generating Spravato at the proper level and with the proper billing process, either buy and bill or administer and observe.

[Daniel Stauder, Director, Equity Research at Citizens JMP]

Great. Appreciate it, guys. Thank you.

[Operator]

Thank you. I would now like to turn the call back over to Keith for closing remarks.

[Keith Sullivan, President, and CEO at Neuronetics]

Thank you, operator. Thank you all for your interest in Neuronetics. I really appreciate your support over the last five and a half years while I've been here. It has been a pleasure working with our three analysts and all of the investors. I look forward to hearing the updates on the Q1 call and getting you updated at that point. Thank you all.

[Operator]

This concludes today's conference call. Thank you for participating, and you may now disconnect.

Participants

Executives

• Cory Anderson, CTO
• Keith Sullivan, President, and CEO
• Steven Pfanstiel, EVP, CFO, and Treasurer

Analysts

• Adam Maeder, Managing Director, Equity Research at Piper Sandler
• Daniel Stauder, Director, Equity Research at Citizens JMP
• Mark Klausner, Managing Partner at ICR Westwicke
• William Plovanic, Managing Director, Equity Research Medical Technology Analyst at Canaccord Genuity