MDxHealth Q4 Earnings Call Highlights

Key Points

• Revenue and volume growth: Q4 revenue rose to $29.5M (up 19% year-over-year) on ~38,000 tests (total unit growth 62%), driven by a 128% increase in liquid-based tests while tissue volumes fell 5%.
• Profitability still pressured: Operating loss widened to $5.3M and net loss to $8.9M, with adjusted EBITDA negative $2.1M, largely due to ExoDx-related expenses and higher financial costs; cash was $29M at year-end.
• ExoDx integration and 2026 targets: Select mdx customer transitions are complete and sales integration should finish by end‑Q1, management expects ExoDx to contribute >$20M in 2026 and aims for adjusted EBITDA of about 10% of revenue by year-end while gross margins remain in the low‑60s.

MDxHealth NASDAQ: MDXH reported fourth-quarter and full-year 2025 results and provided 2026 guidance, with management highlighting continued revenue growth, ongoing integration work following the ExoDx acquisition, and expectations for improving profitability over the course of 2026.

Management framed 2025 around “focus, execution, and growth”

Chief Executive Officer Michael McGarrity said the company’s recent performance has been driven by three core operating principles: focus, execution, and growth. He pointed to a strategy of “menu expansion” across tissue and liquid biopsy products as a key catalyst behind the ExoDx acquisition, which he said positions the company with a precision diagnostics menu “across the patient pathway of prostate cancer.”

McGarrity also emphasized operating discipline—citing reduced operating expenses as a percentage of revenue over the past three years—and commercial productivity, which he said has been reflected in consistent delivery of 20% top-line growth while reducing sales and marketing spend as a percentage of revenue over the same period.

On operations, he highlighted improvements in turnaround time for tissue-based patient samples, noting MDxHealth has moved to “a best-in-class five days or less time to result,” which he described as a key customer experience metric.

Fourth-quarter volumes rose sharply on liquid-based testing

Interim Chief Financial Officer Ron Kalfus said fourth-quarter total billable volume was approximately 38,000 tests, including about 11,000 tissue-based tests and 27,000 liquid-based tests. Total unit growth was 62% versus the prior-year quarter.

• Tissue-based test volumes (Confirm mdx and GPS) decreased 5% year over year.
• Liquid-based test volumes (Select mdx, Resolve mdx, and newly acquired ExoDx) increased 128% year over year.

Revenue rose 19% in Q4; operating and net losses widened

Kalfus reported fourth-quarter revenue of $29.5 million, up 19% from $24.7 million in the prior-year quarter. Gross profit was $18.7 million, up 20% from $15.5 million, and gross margin was 63.2% compared with 62.7% a year earlier. Kalfus attributed the margin improvement primarily to economies of scale.

Below the revenue line, Kalfus said the operating loss increased 14% to $5.3 million, primarily due to higher headcount and other operating expenses related to the ExoDx acquisition. Net loss increased 31% to $8.9 million, driven by a $3.1 million increase in net financial expenses and partially offset by a $1.6 million tax gain. Adjusted EBITDA was negative $2.1 million in the quarter, compared with negative $1.4 million in the prior-year period.

Cash and cash equivalents were $29 million as of Dec. 31, 2025.

ExoDx integration: Select mdx transition completed; sales integration underway

McGarrity said the company began integrating the ExoDx business in the fourth quarter and met an internal goal of transitioning all Select mdx customers to ExoDx, which he said produced operating efficiencies because MDxHealth is no longer receiving Select mdx samples. He added that integration of the sales organization is in progress, including cross-training and “strategic mapping” of the expanded customer base, and is expected to be completed by the end of the first quarter.

He also noted reported full-year revenue of $107.9 million was $1 million lower than a prior approximation shared in a pre-release ahead of the JP Morgan conference. McGarrity said the change resulted from closing-process complexity following the ExoDx acquisition, particularly affecting methodology for calculating average selling prices and top-line revenue. He said the adjustment does not affect 2026 revenue guidance.

McGarrity also discussed an amended earn-out with Exact Sciences related to the GPS acquisition, saying the change lowered an upcoming earn-out payment by close to $20 million and deferred by an additional year the full earn-out amount, which he said provides added flexibility.

2026 outlook and operating leverage priorities

On the call, management reiterated expectations for improving profitability, with McGarrity saying the company expects adjusted EBITDA to reach 10% of revenue as it exits 2026. Addressing questions on quarterly variability, he said the company expected “some chop in Q4 and likely into Q1” as it absorbs the ExoDx acquisition, but expressed confidence in the company’s ability to leverage operating expenses with growth.

In discussing 2026 revenue expectations, McGarrity said he previously signaled an expected $20 million or more contribution from ExoDx in 2026. He said achieving revenue guidance would require balanced growth across tissue and liquid testing, plus capitalizing on cross-selling opportunities across the combined customer base as sales integration is completed.

On gross margin, McGarrity said the company has been “bouncing around in the low 60s” for several quarters and expects margins to continue to range in that area, with quarter-to-quarter fluctuations influenced by product mix and payer mix. He added that the company is “aspirational” about improving margins over time through operating efficiency and pricing leverage, while keeping its current gross margin range as a basis for reaching the targeted EBITDA margin improvement.

Separately, McGarrity highlighted clinical efforts, pointing to progress in a collaboration with the University of Oxford, including completion of the GPS ProMPT study, which the company expects to be presented at the upcoming EAU Congress. He said the Oxford collaboration is moving to the GPS-ProtecT study evaluating GPS in men enrolled in the UK ProtecT randomized trial, and suggested the work could advance GPS utility in clinical guidelines.

About MDxHealth NASDAQ: MDXH

MDxHealth, headquartered in Mechelen, Belgium, with a U.S. presence in Newton, Massachusetts, is a molecular diagnostics company focused on improving the accuracy of cancer diagnosis and treatment decision making through epigenetic biomarker assays. The company specializes in developing and commercializing tests that detect DNA methylation changes associated with urological cancers, enabling more precise risk stratification and patient management.

MDxHealth's lead product portfolio includes ConfirmMDx and SelectMDx.

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