Biodesix NASDAQ: BDSX reported 10% revenue growth for the third quarter of 2026 but said results fell short of its expectations as a smaller-than-planned sales force, seasonal patterns in primary care and delayed customer projects weighed on performance.
The lung diagnostics company revised its full-year revenue outlook to $101 million to $103 million. Chief Financial Officer Robin Harper Cowie said the updated forecast reflects the third-quarter results, the timing of sales hiring and training, and expectations for development services contracts and revenue recognition.
Chief Executive Officer Scott Hutton attributed the shortfall primarily to execution and timing rather than a change in demand. “The greatest impact was really feet on the street,” he said, referring to the number of sales representatives available to acquire new ordering physicians.
Testing Growth Offset by Lower Revenue Per Test
Third-quarter revenue rose to $24 million from $21.8 million a year earlier. Diagnostic testing revenue increased 16% to $23 million, while test volume grew 24% to approximately 19,400, the company’s second-highest quarterly total.
Average revenue per test fell 6% year over year, driven by a higher proportion of Nodify CDT tests. Cowie said improvements in reimbursement coverage for Nodify CDT and Nodify XL2 partially offset that shift. Development services revenue declined to $1 million from $1.9 million as customers delayed the start of several projects.
Gross margin held at 81%, matching the year-earlier period. Biodesix reported an $8 million net loss, an 8% improvement from a year earlier, and an adjusted EBITDA loss of $3.9 million, a 16% improvement.
The company ended the quarter with $28.4 million in cash and cash equivalents, down $1.6 million from June 30. The change included $6.3 million in net proceeds from its at-the-market program.
Sales Hiring and Fourth-Quarter Outlook
Biodesix averaged 101 sales representatives in the field during the quarter, below its target and its second-quarter average. Hutton said higher-than-expected turnover, particularly in newer primary care territories, and slower hiring left representatives focused more heavily on existing accounts rather than acquiring new physicians.
The company now has approximately 110 representatives and plans to exit 2026 with about 115. Hutton said October was the company’s strongest month of the year for new physician acquisitions, while clarifying to an analyst that he was not describing it as a record month overall.
Primary care accounted for approximately 15% of Nodify volumes, consistent with the prior quarter. Hutton said ordering per physician was affected by greater-than-expected seasonality, although physician retention remained strong. Cowie said the company saw a rebound from the seasonal impact in October in both primary care and pulmonology.
For the fourth quarter, Cowie expects development services revenue of roughly $1 million and a sequential increase in lung diagnostic revenue. She said the prior-year fourth quarter included just over $1 million in collections on older claims. Removing that amount, she said, the midpoint of the company’s forecast implies approximately 2% year-over-year growth in diagnostic revenue.
Cowie said many delayed development services projects are expected to move into 2027. She suggested a conservative estimate of 7% to 8% of total revenue for that business next year.
Health System Integrations and New Tests
Hutton highlighted a new American College of Chest Physicians, or CHEST, framework for lung nodule management that identifies validated biomarker testing as a component of risk stratification. He noted that the framework is separate from the society’s clinical guidelines, which he said have not been updated in nearly 13 years.
Two West Coast institutions—a major integrated health system and an academic medical center—have begun implementing lung nodule pathways incorporating Nodify testing, Hutton said. He described the health system’s approach as an administrative-level effort that includes physician education and workflow integration, rather than adoption one physician at a time. He cautioned that it will take time to determine whether such accounts order more tests.
Biodesix is also developing a radiomic-based lung nodule risk assessment test with Vanderbilt University and Vanderbilt Health, with commercialization anticipated in 2028. Its minimal residual disease programs include a tumor-informed assay developed with Bio-Rad Laboratories and a tumor-naïve assay developed with Thermo Fisher Scientific. The company plans to present data from both programs at the upcoming AMP meeting in Seattle, Hutton said.
About Biodesix (NASDAQ:BDSX)
Biodesix, Inc is a data-driven diagnostic solutions company focused on improving the diagnosis and treatment of lung diseases, including lung cancer. The company combines proprietary molecular diagnostic technologies, clinical data, and artificial intelligence to help physicians assess disease risk and make more informed treatment decisions.
Its offerings include blood-based tests designed to help evaluate indeterminate pulmonary nodules, identify patients who may be at higher risk of lung cancer, and support treatment selection and monitoring.
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