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- **Revenue Acceleration**: $48.7M Q3 (+20.6% YoY), driven by U.S. (+21.2%) and TORQ Europe launch. 
- **Profitability Breakthrough**: $2.3M adjusted EBITDA (5% margin), first positive operating cash flow. 
- ** Physician Expansion**: 1,530 active surgeons (+27% YoY), 330 new additions Q3. 
- **Pipeline Momentum**: 510(k) filed for 2026 SI joint solution, TNT NTAP reimbursement increase, and third breakthrough device in development. 
- **Cash Flow Inflection**: $145.7M cash, 2026 free cash flow target, 72% YoY cash consumption reduction.

**【CEO Summary Section】**
- **Revenue Growth**: Q3 2025 revenue reached $48.7 million, up 20.6% YoY, driven by 21.2% U.S. growth and 10.2% international expansion. Key products include iFuse-TORQ (Europe launch) and Granite 9.5 (degenerative spine adoption). 
- **Profitability Milestones**: Achieved $2.3 million adjusted EBITDA (5% margin) and first quarter of positive operating cash flow ($2.3M). 
- ** Physician Engagement**: 1,530 active physicians (+27% YoY), adding 330 new physicians Q3, targeting 12,000+ addressable surgeons across modalities. 
- **Pipeline Progress**: Filed 510(k) for next-gen SI joint solution (Q1 2026 launch), TNT NTAP reimbursement increase ($4.1K/Medicare), and third breakthrough device in development. 

**【CFO Financial Commentary】**
- **Top Line**: U.S. revenue $46.4M (+21.2%), gross profit $38.8M (+21.8%), gross margin 79.8% (up 70bps YoY). 
- **Cost Control**: Operating expenses $44.2M (+11.9%), net loss narrowed to $4.6M (-30% YoY). 
- **Liquidity**: $145.7M cash, net cash flow breakeven Q3, guiding to $198-200M 2025 revenue (+18-20% YoY). 
- **Margin Expansion**: Full year gross margin 79.5%, targeting 78-78.5% medium-term with surgical capacity investments. 

**【Q&A Highlights】**
- ** Physician Density**: 25% of SI joint surgeons perform >1 procedure type; TNT adoption tripled Q3. 
- **Leverage**: 1.7x Q3 operating leverage, 1.25-1.75x 2026 guidance. 
- **2026 Outlook**: TORQ Europe ramp, TNT NTAP, and new SI joint solution launch. 
- **Cash Flow**: Expect $4.3M 2025 net cash use vs. $15.2M prior year, targeting 2026 free cash flow. 
- **Reimbursement**: 17% increase for office-based SI joint procedures, TNT NTAP effective Oct 2025.

SI-BONE, Inc. (SIBN) Q3 2025 Earnings Call Transcript

- **Revenue Growth**: 22% Q2 growth, U.S. up 23% with 25% procedure volume increase.
- **Cash Flow Milestone**: Breakeven achieved in Q2, $145.5M cash on hand.
- **Product Launches**: TORQ in Europe, TNT NTAP effective Oct 1, new SI joint product Q1 2026.
- **Profitability**: 79.8% gross margin, 3rd consecutive quarter of positive EBITDA.
- **Strategic Moves**: Hybrid commercial model expansion, leadership transition to Nikolas Kerr.

**【CEO Summary Section】**
- Delivered 22% worldwide revenue growth, with U.S. revenue up 23% driven by 25% procedure volume increase across all modalities.
- Achieved cash flow breakeven in Q2, ahead of original timeline, with $145.5M in cash and marketable securities.
- Launched iFuse TORQ in Europe, with early surgeon enthusiasm expected to boost international growth in 2026.
- Expanded physician base to 1,440 U.S. surgeons, a 25% YoY increase, with 50% growth in Granite 4-implant cases.
- Announced leadership transition: Tony Recupero retiring in Feb 2026, Nikolas Kerr to become CCO.

**【CFO Financial Commentary】**
- Q2 revenue: $48.6M (21.7% YoY), U.S. $46.4M (22.8% YoY), International $2.2M.
- Gross profit: $38.8M (79.8% margin), up 22.9% YoY due to manufacturing efficiencies.
- Operating expenses: $45.8M (10% YoY), driven by commissions and G&A.
- Adjusted EBITDA: $1M (vs -$2.7M YoY), trailing 12M EBITDA: $3.1M.
- Updated FY25 guidance: Revenue $195-198M (17-18% growth), Gross margin 78.5-79%, Positive EBITDA.

**【Q&A Highlights】**
- **Guidance Cadence**: Q3 expected 4% sequential decline due to seasonality, Q4 growth acceleration.
- **Gross Margin**: 2025 guidance 78.5-79%, medium-term 76-77% as new products scale.
- **Surgeon Engagement**: 63% YoY growth in revenue from residency-trained physicians, 25% YoY surgeon base expansion.
- **International Expansion**: TORQ launch in Europe delayed but strong early feedback, TNT NTAP effective Oct 1 with $4.1K add-on.
- **Pipeline**: New SI joint product 510(k) submission soon, 3rd BDD 510(k) in H2 2026.

SI-BONE, Inc. (SIBN) Q2 2025 Earnings Call Transcript

- **Revenue Super Growth**: Q1 2025 revenue up 25% YoY to $47.3M, driven by 27% U.S. growth and 27.3% procedure volume surge.
- **Margin Expansion**: Gross margin hits 79.7% (vs. 78.9% prior), EBITDA turns positive after $4M loss YoY.
- **Pipeline Power**: Upcoming 2026 SI fusion launch and 3rd FDA Breakthrough Device for spine surgery.
- **Cash Flow Confidence**: $144M cash, targeting 2026 free cash flow with 100 territories by end-2026.
- **Reimbursement Wins**: CMS proposes 8% reimbursement increase for Granite, TNT NTAP boost set for Oct 2025.


**【CEO Summary Section】**
- **Revenue Growth**: Q1 2025 revenue reached $47.3 million, up 25% YoY, driven by 27% U.S. revenue growth and 27.3% procedure volume increase. International revenue was $2.5 million.
- **Product Adoption**: New products like iFuse INTRA, Granite 9.5, and TNT showed strong adoption, with Granite 9.5 cases growing 69% YoY. TORQ adoption expanded among interventionalists.
- **Physician Base Expansion**: 1,400+ U.S. physicians performed procedures, a 27% YoY increase. 43% of physicians performed multiple procedure types, up from prior quarters.
- **Gross Margin**: Improved to 79.7% (up 80bps YoY) due to ASP stability and supply chain efficiencies.
- **Innovation Pipeline**: Upcoming 2026 launch of a new SI joint fusion solution and a third FDA Breakthrough Device targeting spine surgery.

**【CFO Financial Commentary】**
- **Profitability**: Adjusted EBITDA turned positive ($0.5 million) vs. -$4 million YoY. Net loss narrowed to $6.5 million (-38% YoY).
- **Cash Flow**: Ended Q1 with $144.4 million in cash, down $5.6 million (31.7% YoY improvement in cash usage).
- **Guidance Update**: Full-year 2025 revenue guidance raised to $193.5-197.5 million (16-18% growth vs. prior 16-17%). Gross margin expected at 78% (up from 77-78% prior guidance).
- **Free Cash Flow**: Targeting 2026 achievement, with 12-18 month plan to expand to 100 U.S. territories.

**【Q&A Highlights】**
- **New Product Contribution**: TNT adoption ahead of internal expectations, with CMS NTAP reimbursement increase set for Oct 2025. Granite 9.5 adoption outpaced Granite 10.5.
- **Gross Margin Trends**: Q1 79.7% margin may not repeat due to lower ASP in trauma/degenerative cases, but 78% full-year target achievable.
- **Sales Team Leverage**: Territory productivity reached $2 million (up 25% YoY), with plans to expand to 100 territories by end-2026.
- **Regulatory Outlook**: CMS proposed 8% reimbursement increase for Granite multi-level procedures, with potential reassignment to higher DRG category.
- **Macro Resilience**: Procedures less susceptible to economic downturns due to patient pain severity; 2024 resident/fellow revenue grew 64% YoY.


SI-BONE (SIBN)-5 May 25-2025 Q1 Earnings call transcript

- **Revenue Growth**: Q4 2024 revenue up 26% YoY to $49 million, driven by 28% U.S. growth and 23% active physician expansion.
- **Product Momentum**: Granite 9.5 adoption surged 45% YoY in stack cases; TNT exceeded expectations in first quarter.
- **Profitability**: Q4 2024 adjusted EBITDA turned positive ($1.9M) vs. $4.8M loss in Q4 2023; full-year 2024 loss narrowed 70% to $5.1M.
- **2025 Outlook**: Target $193.5-$195.5M revenue (16-17% YoY growth), 77-78% gross margin, and positive free cash flow.
- **Innovation**: Second FDA Breakthrough Device Designation awarded; TNT NTAP approval potential in Q4 2025.


**【CEO Summary Section】**
- **Record Q4 Revenue Growth**: Achieved $49 million in worldwide revenue, up 26% YoY, driven by 28% U.S. revenue growth to $46.9 million. Active physician base expanded to 1,400, up 23% YoY, with 260 new additions in Q4.
- **Product Line Success**: Granite 9.5 adoption outpaced prior launches, TNT exceeded expectations in its first quarter, and TORQ/INTRA strengthened interventional spine engagement. Q4 stack Granite volume grew 45% YoY.
- **Profitability Milestone**: Delivered $1.9 million positive adjusted EBITDA in Q4, vs. $4.8 million loss in Q4 2023. Full-year 2024 adjusted EBITDA narrowed to $5.1 million loss (vs. $17.3 million in 2023).
- **2025 Growth Priorities**: Expand commercial infrastructure, increase procedure density via multimodality engagement, and prepare for new product launches. Targeted 2025 revenue of $193.5-$195.5 million (16-17% YoY growth).

**【CFO Financial Commentary】**
- **Revenue Performance**: Full-year 2024 revenue $167.2 million (+20% YoY), U.S. $158.4 million (+21% YoY). Q4 gross margin 79%, up 100bps vs. FY24 guidance due to ASP strength and supply chain efficiency.
- **Profitability Trends**: Q4 net loss $4.5 million (-60% YoY), full-year net loss $30.9 million (-29% YoY). Operating expenses grew 7% YoY to $167.4 million, driven by sales commissions (+20%) and R&D (+15%).
- **Liquidity**: Ended 2024 with $150 million cash, targeting positive free cash flow in 2025. 2025 guidance assumes 77-78% gross margin and 9% OpEx growth.

**【Q&A Key Themes】**
- **Competitive Position**: Maintained leadership in SI joint fusion with 1,400 active surgeons, 70% revenue growth from academic-trained physicians. Differentiated by comprehensive product portfolio and clinical data.
- **Product Contribution**: TNT adoption exceeded expectations in Q4, Granite 9.5 driving degenerative spine and pelvic fixation growth. TNT NTAP approval potential in Q4 2025 could accelerate revenue.
- **Margin Dynamics**: 2025 gross margin guided to 77-78% due to procedure mix (lower implant usage in certain cases). Long-term target of 76-77% reflects ongoing supply chain optimization.
- **Regulatory Update**: Second FDA Breakthrough Device Designation awarded for novel implant system, positioning for future category creation.
- **DOJ Investigation**: Cooperating transparently, no material updates expected prior to resolution.


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