Neuronetics NASDAQ: STIM reported first-quarter 2026 results that management said were largely in line with expectations, as the company balanced growth in its Greenbrook clinic business with a slight decline in overall NeuroStar revenue. President and CEO Dan Reuvers, who led his first earnings call in the role, also addressed a CFO transition, cost actions, and ongoing evaluation of the company’s structure following shareholder commentary.
Leadership updates and early priorities
Reuvers said he joined Neuronetics after roughly 35 years in medtech leadership roles, most recently as CEO of Tactile Medical. Since stepping into the role, he said he has spent the last month on a “listening tour,” including time with the field team, in clinics, and with customers, as well as engagement with shareholders and analysts.
Reuvers highlighted opportunities he sees across both parts of the business. On the NeuroStar side, he said he sees an opportunity to “broaden how we go to market and reach customer segments where we’ve not historically been positioned to compete.” Within Greenbrook clinics, he emphasized workflow and revenue cycle management as key levers to optimize profitability, citing both patient flow and minimizing operational handoffs.
Reuvers also noted a CFO transition. He said Steven Pfanstiel “departed earlier this month to pursue an opportunity outside Neuronetics,” and the company has started a search for a successor.
NeuroStar and Greenbrook performance in the quarter
Reuvers said NeuroStar shipped 34 systems in the quarter, up 10% year-over-year. He also said the company is modernizing customer support through “more virtual, on-demand, and real-time engagement tools” and is piloting an “expanded set of commercial models” intended to broaden NeuroStar’s reach. He said early feedback on those pilots has been positive, with more to share in August.
At Greenbrook, Reuvers said clinic revenue grew 15% in the quarter, driven by strength in SPRAVATO and expansion of buy-and-bill. He said TMS volumes in the clinics were “modestly below prior year levels,” which management attributed in part to weather disruptions, particularly in January and February, with better performance in March.
During the Q&A, Reuvers told Canaccord Genuity analyst Bill Plovanic that SPRAVATO grew in both buy-and-bill and “A&O” segments, “double-digit in both,” and that buy-and-bill mix has “equilibrate[d] over the last couple of quarters.” He also said marketing spend was “a little lumpy” exiting last year, and that the company is smoothing investment across the year to support consistency.
Financial results: revenue up, margins pressured by mix
Total revenue for the first quarter was $34.5 million, up 8% from $32.0 million in the prior-year quarter, which management said was primarily driven by higher U.S. clinic revenue.
- NeuroStar revenue: $12.9 million, down 3% year-over-year.
- U.S. NeuroStar system revenue: $3.2 million, up 13% year-over-year, with 34 systems shipped.
- U.S. treatment session revenue: $9.1 million, down 5% year-over-year. Management said utilization increased 3.5% but was offset by lower customer inventory levels.
- U.S. clinic revenue: $21.5 million, up 15% year-over-year, driven by strong SPRAVATO growth and overall pricing improvement.
Gross margin was 46.9% versus 49.2% in the prior-year quarter. Reuvers attributed the decline primarily to revenue mix, with clinic revenues representing a higher portion of total revenue, and to the increased impact of SPRAVATO buy-and-bill compared with the year-ago quarter when the offering was still being launched.
Operating expenses were $25.1 million, down 6% from $26.8 million, driven primarily by SG&A efficiencies. Net loss narrowed to $10.8 million, or $0.16 per share, compared with a net loss of $12.7 million, or $0.21 per share, in the prior-year quarter. Adjusted EBITDA improved to negative $6.6 million from negative $8.6 million.
Cash, debt amendment, and cost actions
As of March 31, total cash was $19.0 million, compared with $34.1 million at December 31. Cash used by operations was $9.4 million, compared with $17.0 million in the first quarter of 2025, which management described as a $7.6 million improvement year-over-year.
Reuvers said the company amended its debt agreement with Perceptive Advisors in March 2026 to reduce outstanding debt obligations and interest expense. Under the amendment, Neuronetics made a one-time principal payment of $5 million and adjusted existing debt covenants.
Reuvers also said the company took steps to better align its cost structure, with expected annualized savings of approximately $2.5 million to $3 million and net savings beginning in the third quarter. “Profitability and cash are top priorities,” he said.
In response to a question about liquidity, Reuvers said the company believes it has “sufficient headroom in the balance sheet to take us through the year,” citing operating cash flow expectations and the company’s full-year burn assumptions.
Guidance maintained; strategic considerations and external catalysts
Neuronetics maintained its 2026 guidance, calling for:
- Total revenue: $160 million to $166 million
- Gross margin: 47% to 49%
- Operating expenses: $100 million to $105 million (including about $8.5 million of non-cash stock-based compensation)
- Cash flow from operations: negative $13 million to negative $17 million
Reuvers said operating cash flow is projected to improve beginning in the second quarter and sequentially through the remainder of the year, with operating cash flow “flat to positive” during the second half of the year. For the second quarter, he said the company expects mid-single-digit growth.
Reuvers also acknowledged shareholder views suggesting a separation of the NeuroStar and Greenbrook businesses could unlock value. He said he is evaluating the business “with an open mind” and emphasized that the board and management are focused on disciplined decision-making that creates long-term shareholder value.
In the Q&A, Reuvers said he believes the company has “underpunched our weight” recently in NeuroStar and described expanding the “go-to-market menu” as a potential catalyst. He also discussed the balance between driving utilization and expanding the installed base, saying both are important and that the company wants to ensure NeuroStar units are placed in clinics “regardless…of what economic model is in place.”
Reuvers also pointed to potential longer-term opportunity from Compass Pathways’ pending psilocybin therapy, noting that the regulatory process is Compass’s to navigate and that the Trump administration’s recent executive order prioritizing such submissions was “encouraging.” If approved, he said Greenbrook is “among a very small number of providers genuinely equipped to deliver it,” though he cautioned that, similar to SPRAVATO, the revenue ramp would likely be “measured in the first year of launch.”
Additionally, Reuvers referenced UnitedHealthcare and Optum’s coverage policy change allowing nurse practitioners to deliver TMS, saying it could expand the company’s target list by enabling the company to revisit clinics where TMS “wasn’t a viable option” under prior reimbursement limitations. He noted the change affects 35 million covered lives across 26 states and said it is still early in the rollout.
About Neuronetics NASDAQ: STIM
Neuronetics, Inc 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.
Further Reading
This instant news alert was generated by narrative science technology and financial data from MarketBeat in order to provide readers with the fastest reporting and unbiased coverage. Please send any questions or comments about this story to contact@marketbeat.com.
Before you consider Neuronetics, you'll want to hear this.
MarketBeat keeps track of Wall Street's top-rated and best performing research analysts and the stocks they recommend to their clients on a daily basis. MarketBeat has identified the five stocks that top analysts are quietly whispering to their clients to buy now before the broader market catches on... and Neuronetics wasn't on the list.
While Neuronetics currently has a Hold rating among analysts, top-rated analysts believe these five stocks are better buys.
View The Five Stocks Here
MarketBeat just released its list of the 7 hottest IPOs expected to hit Wall Street in 2026. See which companies are preparing to go public and why investors are watching closely.
Get This Free Report
