Neuronetics (NASDAQ:STIM) reported fourth-quarter 2025 financial and operating results highlighted by its first full year operating with the Greenbrook clinic network, strong adjusted pro forma revenue growth, and positive operating cash flow in the quarter. Management also announced a leadership transition, with the board appointing Dan Reuvers as the company’s next president and chief executive officer, effective March 23.
Leadership transition and integrated-model update
Outgoing President and CEO Keith Sullivan said the company’s strategy following the Greenbrook acquisition was to build a “vertically integrated mental health company” combining technology, clinical infrastructure, and scale to expand patient access to treatment. Sullivan said the combined company delivered “strong fourth quarter results” and reached a key milestone of positive operating cash flow in the period.
Greenbrook clinic network: referrals, Spravato rollout, and operational changes
Management reported strong growth across Greenbrook during 2025. Sullivan said full-year clinic revenue grew 28% on an adjusted pro forma basis, supported by increased field engagement and a growing network of referring providers.
- In the fourth quarter, the referring provider network added 430 new providers, a 25% year-over-year increase.
- Across 2025, the network added more than 1,300 new referrers.
- Regional teams completed more than 47,000 physician outreach activities during the year.
- Fourth-quarter patient referrals exceeded 2,300, a 46% increase over the prior-year period.
Sullivan said process improvements—such as an automated patient transfer process, educational tools, scheduling QR codes, and a coordinated intake team—are designed to engage patients while they are still in a primary care setting and to improve conversion from referral to treatment.
On Spravato, Sullivan said the rollout is “nearly complete,” with 84 clinics providing the treatment. He added the company has optimized billing practices based on the economics of “buy and bill” versus “administer and observe,” and is deploying billing models in a state-, payer-, and clinic-specific manner. He said total treatment volume across Spravato and TMS rose 18% year-over-year in the fourth quarter.
Operationally, management described standardization efforts across the clinic network, including deploying tablet kiosks to streamline check-in and facilitate point-of-visit collection of patient responsibility payments. The company is also piloting a patient portal intended to enable digital intake and is beginning to use AI in benefits investigation to file claims faster and improve first-pass acceptance rates while reducing labor.
NeuroStar performance and provider programs
Neuronetics reported a strong quarter for NeuroStar system shipments. Sullivan said the company shipped 49 systems in the quarter, with average selling price above its target for a fourth consecutive quarter. He attributed this performance in part to a deliberate realignment of the capital sales team toward “TMS-ready accounts” that can credential with payers and begin treating patients faster.
On a pro forma basis, management said treatment session revenue increased 6% in the fourth quarter, supported by 11% growth in treatment utilization. Sullivan also provided an update on the BetterMe Provider (BMP) program, noting that the program ended 2025 with more than 420 active sites and nearly 100 additional sites working toward qualification. Since inception, the program has connected more than 66,000 interested patients with BMP providers, and management said BMP sites deliver higher patient volumes and faster response times than non-participating sites.
Management also cited growing recognition of NeuroStar TMS for adolescents. Sullivan said TRICARE West expanded coverage for TMS therapy to include adolescents age 15 and older diagnosed with depression, effective across 26 states.
Separately, the company discussed traction in a provider connection program launched in April. Sullivan said the field team held more than 400 educational meetings, resulting in more than 210 new referral sites by year-end. He described the effort as applying Greenbrook’s experience educating primary care physicians to the broader NeuroStar customer base.
Sullivan also said Neuronetics is leveraging Greenbrook’s infrastructure to provide services to NeuroStar customers, including benefits investigations and patient management support through the company’s intake center. He cited partners including Transformations Care Network and Elite DNA, and said these services are already driving new patient starts at partner sites.
Financial results, cash flow progress, and 2026 outlook
Chief Financial Officer Steve Pfanstiel said fourth-quarter total revenue was $41.8 million, up 86% year-over-year, primarily due to the inclusion of Greenbrook operations. On an adjusted pro forma basis, revenue increased 23% versus the prior year.
For the quarter, NeuroStar revenue (systems plus treatment sessions) was $18.3 million. On a pro forma basis, Pfanstiel said this represented 9% growth year-over-year. U.S. system revenue was $4.4 million, up 15% on a pro forma basis, with 49 systems shipped. U.S. treatment session revenue was $12.4 million; on a pro forma basis it increased 6%, though Pfanstiel noted a reported decline of 4% due primarily to the absence of prior-year intercompany purchases from Greenbrook.
Clinic revenue was $23.5 million, which Pfanstiel said represented 37% adjusted pro forma growth, driven by increased treatments across both NeuroStar TMS and Spravato.
Gross margin was 52% in the fourth quarter, down from 66% in the prior-year quarter, reflecting the inclusion of Greenbrook’s lower-margin clinic business. Pfanstiel said the fourth-quarter gross margin was the company’s highest quarterly margin of the year, citing clinic efficiency efforts and favorable product mix.
Operating expenses were $26.7 million, up 1.4% year-over-year, reflecting the inclusion of $8.5 million of Greenbrook G&A expenses, partially offset by lower R&D expense. The quarter included $2.2 million of non-cash stock-based compensation. Net loss was $7.2 million, or $0.10 per share, compared to a net loss of $12.7 million, or $0.34 per share, a year earlier. Fourth-quarter EBITDA was negative $4.3 million versus negative $11 million in the prior year.
On cash and liquidity, Pfanstiel said total cash was $34.1 million at Dec. 31, 2025, including $28.1 million of cash and cash equivalents and $6.0 million of restricted cash, compared with $19.5 million at year-end 2024. Cash provided by operations in the fourth quarter was positive $0.9 million. Pfanstiel said operating cash burn improved sequentially each quarter during 2025, from negative $17 million in the first quarter to positive $0.9 million in the fourth quarter.
Management also discussed a March 2026 amendment to its debt agreement with Perceptive, including a one-time $5 million principal payment and covenant adjustments. In the Q&A, Pfanstiel said the payment did not come from restricted cash and estimated the debt paydown would reduce annual interest expense by close to $600,000.
For 2026, the company guided to total revenue of $160 million to $166 million, with the midpoint implying greater than 9% growth versus 2025. Pfanstiel said the clinic business is expected to grow in the double digits to mid-teens, while the NeuroStar business is expected to grow in the low to mid-single digits. First-quarter 2026 revenue guidance was $33 million to $35 million, with management citing seasonality in both clinic volume and capital sales, as well as weather-related impacts. The company guided to full-year gross margin of 47% to 49% and operating expenses of $100 million to $105 million, inclusive of approximately $8.5 million of non-cash stock-based compensation. Full-year 2026 operating cash flow is expected to be negative $13 million to negative $17 million, with management projecting the highest cash burn in the first quarter and improvement beginning in the second quarter, with positive operating cash flow in the second half.
Strategic initiatives: new commercial models and Compass collaboration
Looking ahead, Sullivan said the company is focused on two initiatives in 2026: expanding how it brings NeuroStar TMS systems to market by piloting new customer acquisition models, and driving growth in demand at Greenbrook clinics for depression treatments.
On potential new modalities, Sullivan highlighted the company’s collaboration with Compass Pathways on COMP360 psilocybin for treatment-resistant depression (TRD). He said Compass has completed two phase 3 studies showing “highly statistically significant and clinically meaningful results,” including durable improvement through at least 26 weeks after one or two doses, and that Compass plans to submit an NDA with the potential for an FDA decision by year-end. Sullivan said the Greenbrook network is positioned to offer REMS-compliant therapies and expects only limited incremental investment to support COMP360 if approved, given alignment with existing Spravato operations.
In the Q&A, Greenbrook executive Cory Anderson said COMP360 would be administered in supervised doses within a clinic setting, without a daily or recurring protocol, and would be administered under a REMS protocol similar to Spravato. Anderson also said Compass has about seven strategic collaborations for commercial readiness and that Greenbrook is one of them. Pfanstiel added that the company is working with Compass on reimbursement considerations and intends to focus on profitability, drawing comparisons to the company’s approach to Spravato billing models.
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.
