Neuronetics Reports Record 2025 Financial Results, Greenbrook Clinic Growth, and 2026 Outlook with New CEO Appointment

Neuronetics (NASDAQ: STIM) Q4 and Full Year 2025 Financial Results: Investor Highlights

Key Points from Neuronetics’ Q4 and Full Year 2025 Report

Exceptional Revenue Growth: Q4 2025 revenue reached \$41.8 million, up 86% year-over-year, and full-year revenue surged to \$149.2 million, an increase of 99% from 2024.
Greenbrook Acquisition Drives Performance: Greenbrook clinic revenue was \$23.5 million in Q4 (+428% YoY), and \$87.0 million for the full year (+1,857% YoY), marking a transformative impact on the company’s topline.
Positive Operating Cash Flow: Neuronetics achieved positive operating cash flow in Q4 2025 (\$0.9 million), reflecting improved financial discipline and cash collection efforts.
Strategic Collaboration: The company advanced its partnership with Compass Pathways on COMP360 psilocybin, targeting treatment-resistant depression with Phase 3 results showing durable improvement.
Expanded Insurance Coverage: TRICARE West broadened coverage for TMS therapy, including NeuroStar, to adolescents aged 15+, expanding the addressable market for non-drug depression treatments.
Leadership Change: Dan Reuvers, a seasoned medical device executive, will take over as President & CEO effective March 23, 2026.
2026 Outlook: For 2026, Neuronetics expects revenue between \$160 million and \$166 million, with operating expenses projected at \$100-105 million and gross margin between 47-49%.

Detailed Financial & Operational Review

Quarterly and Annual Growth

Neuronetics delivered robust growth in Q4 2025, with total revenue of \$41.8 million, driven by the acquisition and integration of Greenbrook clinics. U.S. revenues climbed 88% to \$40.7 million, while international revenues grew 31% to \$1.1 million. The Greenbrook acquisition contributed an incremental \$19 million to clinic revenue in Q4 alone.

For the full year 2025, revenues nearly doubled to \$149.2 million. U.S. revenues were \$146.0 million (+101% YoY), and international revenues totaled \$3.1 million (+29% YoY). Clinic revenue from Greenbrook soared to \$87.0 million for the year, reflecting successful expansion and integration.

Segment Performance

NeuroStar Advanced Therapy System: Q4 system revenue was \$4.4 million (+15% YoY), with 49 systems shipped. Full-year system revenue was \$14.3 million (down 7% YoY), with 161 systems shipped. The decrease is attributed to targeting strategic high-volume accounts.
Treatment Sessions: Q4 treatment session revenue was \$12.4 million (down 4% YoY), primarily due to the absence of Greenbrook’s prior session revenue. On a pro forma basis, session revenue grew 6% YoY. Full-year session revenue was \$43.3 million (down 15% YoY), but pro forma growth was 1.7%.
Clinic Revenue: Greenbrook clinics generated \$23.5 million in Q4 and \$87.0 million for the year, with adjusted pro forma growth of 37% and 28%, respectively.

Profitability and Margins

Gross margin decreased to 52.0% in Q4 (vs. 66.2% in Q4 2024) and 48.5% for the full year (vs. 72.3% in 2024), primarily due to the inclusion of Greenbrook’s clinic business. Operating expenses rose slightly in Q4 to \$26.7 million, and full-year expenses increased 16.9% to \$103.7 million, mainly from Greenbrook integration.

Net loss improved in Q4 to \$(7.2) million (vs. \$(12.7) million in Q4 2024), and for the year to \$(39.1) million (vs. \$(43.7) million in 2024), reflecting improved operational efficiency and expanded revenue base.

Balance Sheet and Cash Flow

Cash Position: As of December 31, 2025, the company held \$34.1 million in cash and restricted cash, up from \$19.5 million in 2024.
Debt Reduction: March 2026 saw an amended agreement with Perceptive Advisors, reducing debt and interest expense via a \$5 million principal payment and covenant adjustments.
Cash Flow: Q4 operating cash flow was positive (\$0.9 million), marking continued improvement and validation of operational changes.

Strategic and Operational Developments

CEO Appointment: Dan Reuvers, with over 30 years of medical device leadership, will replace Keith Sullivan as CEO, bringing experience from Tactile Medical, where he drove revenue and record cash flow.
Compass Pathways Collaboration: Two phase 3 studies for COMP360 psilocybin showed clinically meaningful, durable effects in treatment-resistant depression. An NDA submission and potential FDA decision are expected within 2026.
TRICARE West Policy Change: TMS therapy coverage expanded to adolescents aged 15+, increasing access for military families across 26 states. This could significantly increase addressable patient populations.
Milestone Achievement: Over 237,000 global patients treated with more than 8 million NeuroStar treatment sessions; Greenbrook centers have delivered over 2 million treatments to 60,000 patients.

2026 Guidance and Outlook

Q1 2026: Expected revenue of \$33–35 million.
Full Year 2026:
- Total revenue: \$160–166 million
- Gross margin: 47–49%
- Operating expenses: \$100–105 million (including ~\$8.5 million non-cash stock-based compensation)
- Operating cash flow: \$(13)–\$(17) million
- Operating expense reduction anticipated in H2 2026, with annualized expenses below \$100 million by Q4.
Operating cash flow expected to improve significantly, driven by revenue growth, cost reduction, and working capital improvements.

Potentially Price-Sensitive Developments for Shareholders

Greenbrook Acquisition Impact: The acquisition was a major driver of 2025 financial performance and will continue to shape revenue and operational results. Any synergies or integration challenges could materially affect future results.
Leadership Transition: The appointment of Dan Reuvers as CEO marks a pivotal leadership change and could affect strategic direction, operational execution, and investor confidence.
COMP360 Psilocybin Collaboration: Successful FDA approval and subsequent commercialization could open a significant new revenue stream and position Neuronetics as a leader in innovative neurohealth treatments for depression.
TRICARE Policy Expansion: Broader insurance coverage for TMS therapy, including adolescent patients, expands the addressable market and could drive future growth.
Debt Reduction: Amended debt agreement with Perceptive Advisors reduces financial risk, interest expense, and strengthens the balance sheet.
2026 Guidance: Continued strong revenue growth, margin stabilization, and expense reduction targets—if achieved—may positively influence share price and investor sentiment.
Gross Margin Compression: While revenue is up, gross margin has declined due to clinic business inclusion. Investors should watch for future margin improvements or additional cost-saving initiatives.
Improved Net Loss: Narrowing net losses and positive operating cash flow in Q4 are signs of improving financial health, which may support share value.

Other Notable Details

Product Portfolio: NeuroStar Advanced Therapy System (FDA-cleared for MDD, OCD, anxious depression, and as first-line adjunct in adolescent patients aged 15–21). Greenbrook centers also offer SPRAVATO® (esketamine) for treatment-resistant depression.
Patient Impact: Over 8 million NeuroStar treatments delivered globally, with the largest clinical depression outcomes registry.
Non-GAAP Measures: EBITDA and pro forma revenue are provided for better investor insight, but these measures should be interpreted with caution.

Disclaimer

This article is for informational purposes only and does not constitute investment advice. All forward-looking statements are subject to risks and uncertainties that may cause actual results to differ materially. Investors should review Neuronetics’ latest SEC filings for more comprehensive risk disclosures. This article is based on the company’s published financial and operational results as of March 17, 2026.