NeoGenomics NASDAQ: NEO reported first-quarter 2026 results that management said reflected continued momentum in its clinical business and growing contributions from newer, higher-value oncology tests. Total revenue rose 11% year-over-year to $186.7 million, exceeding the company’s guidance, while adjusted EBITDA increased 27% to $9.0 million.
Q1 revenue growth led by clinical testing and NGS
Chief Executive Officer Tony Zook said the quarter delivered “double-digit revenue growth,” supported by a portfolio shift toward therapy selection and molecular residual disease (MRD) offerings. Clinical revenue increased 14% year-over-year to $171.2 million, driven by 6% volume growth and an 8% increase in average unit price (AUP), management said.
Chief Financial Officer Abhishek Jain noted that excluding the company’s Pathline acquisition, same-store revenue was $167.9 million, up 12% year-over-year, reflecting a 3% increase in test volumes and a 9% increase in AUP. Jain added that results came in at the “high end of our expectations despite the anticipated impact of strategically exiting a high-volume, low-value contract.” Later in the Q&A, Jain said the contract represented about 3% to 4% of total volumes in 2025 and that its impact on overall AUP growth was “about one point or so.”
Next-generation sequencing (NGS) remained a key growth driver. Zook said NGS revenue grew 26% year-over-year, “well ahead of the NGS market growth rate,” and now represents about one-third of clinical revenue. During Q&A, Zook said the 26% NGS revenue growth included 16% volume growth, and Jain attributed the remainder to AUP improvement and mix shifting toward “larger CGP panels.”
Commercial strategy: focus on community oncology, workflow, and local scale
President and Chief Operating Officer Warren Stone emphasized the company’s focus on community oncology settings, where he said “approximately 80% of patients seek treatment.” Stone argued that community physicians prioritize guideline-driven, actionable results and partners that “reduce friction and support confidence treatment decisions.”
Stone highlighted several infrastructure elements intended to support adoption, including a network of more than 300 payer contracts and “over 330 interfaces,” including Epic Aura. He cited third-party research suggesting Epic Aura “could drive a 20%-30% increase in test adoption per site,” and later told analysts the company went live with its first Epic Aura customer earlier in the month and is building a pipeline for additional activations through the year. Stone said NeoGenomics is targeting Epic Aura implementations for therapy selection and MRD and expects adoption benefits to build as implementations scale.
On Pathline, Stone said the acquisition strengthened NeoGenomics’ Northeast presence and “grew at 1.5x our national average.” In Q&A, management said the Northeast was also the region “most affected by weather” in the first quarter and that Pathline-related volumes have been influenced by exiting non-oncology business and by load balancing testing across the company’s lab network.
Product updates: RaDaR ST MRD launch and PanTracer portfolio expansion
Stone discussed the late-February full clinical launch of RaDaR ST, a circulating tumor DNA assay for MRD with “detection as low as 1 ppm.” He said the launch targets two approved indications—HPV-negative head and neck cancer and a subset of breast cancer—and that the company has submitted two additional cancer indications to MolDX for reimbursement. Stone said that if reimbursement is granted, it would “more than double our market opportunity.”
Stone characterized early launch indicators as encouraging, stating that about 29% of customers who previously used RaDaR 1.0 have ordered RaDaR ST since launch, and that 34% of RaDaR ST orders included additional NeoGenomics tests. He also said results to date have been delivered faster than published turnaround times.
NeoGenomics also discussed its PanTracer therapy selection portfolio. Stone described PanTracer liquid biopsy (PanTracer LBx) as a blood-based test for identifying key genomic alterations in advanced-stage tumors, and said that after MolDX reimbursement was received, revenue contributions are expected “to ramp throughout the year.” He also detailed PanTracer Pro, which integrates comprehensive genomic profiling with immunohistochemistry (IHC) and other tests from a single requisition and sample. Stone said the intent is to turn a “fragmented” workup into a coordinated workflow, with certain add-on results available by day 4 and genomic profiling results by day 8 in an example presented for ovarian cancer.
In Q&A, Zook said PanTracer Pro—introduced in mid-February—represented “almost over 10% of PanTracer volume” and had captured “15% of new users.” Stone added that tissue and liquid testing are often used concurrently, including as a reflex when tissue quantity is insufficient.
Looking ahead, Stone said the company is making targeted R&D investments in whole genome sequencing, including a next-generation MRD assay and a whole genome solution for hematologic malignancies. He said the next-generation MRD platform is progressing, with data generation expected next year and a potential launch “as early as 2028.”
Margins, cash flow, and updated 2026 guidance
Jain said adjusted gross profit rose $7 million, or 9%, year-over-year, while adjusted gross margin was 46%, down 80 basis points. He attributed the decline primarily to the dilutive impact of the Pathline acquisition and the launch of PanTracer liquid prior to MolDX approval, which he said combined for roughly 150 basis points of headwind in the quarter. Jain also cited higher freight costs and fuel surcharges tied to geopolitical conditions, partially offset by AUP gains and lab efficiency.
Operating expenses were $99 million, down 2% year-over-year. Jain said the company plans targeted investments in sales and R&D while continuing to improve leverage in general and administrative spending. Cash used in operations was $8.1 million, improving from about $25.3 million a year earlier, and NeoGenomics ended the quarter with $146 million in cash. Jain reiterated a goal of being free cash flow positive in 2026.
Based on first-quarter performance and what Jain described as earlier-than-assumed MolDX approval of PanTracer liquid in March, NeoGenomics raised full-year revenue guidance to $797 million to $803 million from $793 million to $801 million. The company maintained adjusted EBITDA guidance of $55 million to $57 million.
Management outlined key revenue assumptions at the midpoint, including:
- RaDaR ST revenue remaining in the “mid-single-digit” millions
- PanTracer liquid revenue expected to be in the “mid-single-digit” millions following MolDX approval
- Non-clinical revenue expected to decline low- to mid-single digits year-over-year in 2026
For quarterly cadence, Jain suggested modeling about 9% year-over-year revenue growth in the second quarter, 9% to 10% in the third quarter, and above 10% in the fourth quarter.
Questions on payer mix, non-clinical softness, and refinancing plans
On the non-clinical business, Jain said first-quarter revenue was $15.5 million, down 15% year-over-year due to “expected softness in pharma,” partially offset by double-digit growth in the company’s oncology data solutions (ODS) business. He said the company believes it is “near the bottom” and expects sequential growth in the back half of the year.
Asked about payer mix and reimbursement dynamics for liquid biopsy and RaDaR ST, Jain used PanTracer tissue as a proxy and said the company expects about 40% of payments from Medicare and Medicaid, with additional contributions from Medicare Advantage and commercial payers. For RaDaR ST, he said Medicare is about 20% to 25%, Medicare Advantage 10% to 15%, with the remainder from commercial and Medicaid “tail.” He said commercial coverage expansion takes time but noted NeoGenomics’ existing payer relationships as an advantage in pursuing coverage policies.
On capital structure, Jain said the company is in discussions with banks regarding refinancing its convertible notes due January 2028 and that the plan is to complete refinancing in the second half of the year.
Zook said the company is watching for MolDX reimbursement decisions on two additional RaDaR ST indications later this year and plans to expand its sales force by the third quarter, including adding roughly 25 sales resources to support MRD penetration. He said these catalysts, combined with ongoing investments in automation and lab optimization, are intended to support growth in 2026 and beyond.
About NeoGenomics NASDAQ: NEO
NeoGenomics, traded on the Nasdaq under the symbol NEO, is a leading provider of cancer-focused genetic and molecular testing services. Headquartered in Fort Myers, Florida, the company operates an integrated network of CAP-accredited and CLIA-certified laboratories across the United States, Europe and Asia. NeoGenomics delivers diagnostic insights that support oncologists, pathologists and healthcare institutions in the detection, prognosis and treatment of hematologic and solid tumor cancers.
The company's core service offerings include flow cytometry, immunohistochemistry, fluorescence in situ hybridization (FISH), karyotyping and advanced molecular assays such as next-generation sequencing (NGS) panels and polymerase chain reaction (PCR) tests.
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