Executive Summary

Q4 revenue grew 36% year over year to $15.3M on strong U.S. Heart Failure adoption; gross margin was 83% (down ~200 bps YoY on higher cost per unit); net loss per share was $0.43 .
U.S. HF revenue rose 41% YoY to $14.3M on 457 revenue units, driven by more territories, new accounts, and rising physician/patient awareness; active implanting centers reached 223 (vs. 178 YE23) .
Reimbursement backdrop improved materially into 2025: inpatient DRG reassigned to ~$43k (effective Oct 1, 2024) and outpatient OPPS placement maintained at ~$45k for 2025, effectively equalizing settings and supporting access .
FY25 guidance maintained: revenue $63–$65M, gross margin 83–84%, OpEx $100–$104M; Q1’25 revenue guided to $14.5–$15.0M; management expects typical Q1 seasonality, then steady growth through 2025 .

What Went Well and What Went Wrong

What Went Well
- U.S. HF growth accelerated: Q4 U.S. HF revenue +41% YoY to $14.3M on 457 units; sales territories expanded to 48 and active implanting centers to 223 .
- Reimbursement milestones: CMS maintained outpatient payment at ~$45k for 2025 (OPPS APC 1580) and increased inpatient payment to ~$43k (DRG 276), equalizing settings and improving access .
- Strategic focus and tone: “We capped off a very strong 2024… well‑positioned to drive the continued adoption of Barostim therapy,” CEO Kevin Hykes noted, citing a world‑class sales org and priority programs to deepen utilization and address adoption barriers .
What Went Wrong
- Gross margin modestly compressed to 83% (vs. 85% LY) due to higher cost per unit, partially offset by volume leverage .
- Operating intensity remained elevated: Q4 SG&A rose 19% YoY to $20.2M on headcount, stock‑based comp, and travel; FY24 OpEx reached $91.3M (included ~$8.4M one‑time CEO option mod in Q1’24) .
- Europe mixed: Q4 Europe revenue flat at $1.0M with units down to 41 (from 52), and management trimmed 1 OUS territory amid spend discipline .

Financial Results

Income statement snapshot (company-reported)

Metric	Q2 2024	Q3 2024	Q4 2024
Revenue ($M)	$11.807	$13.373	$15.342
Gross Profit ($M)	$9.907	$11.125	$12.771
Gross Margin (%)	84%	83%	83%
Total OpEx ($M)	$23.880	$24.136	$23.045
Loss from Operations ($M)	$(13.973)	$(13.011)	$(10.274)
Net Loss/Share (basic & diluted)	$(0.65)	$(0.57)	$(0.43)
Weighted Avg Shares (M)	21.63	22.78	24.72

Q4 2024 vs Wall Street consensus
- Consensus revenue and EPS from S&P Global were not retrievable at this time due to system limits; we cannot determine a beat/miss for Q4 2024. We attempted to fetch consensus for Q4 2024 and Q1 2025 but were unable to retrieve the data.
Segment and geography

Q4 2024 Segment Detail	Amount/Units
U.S. Revenue ($M)	$14.4
U.S. HF Revenue ($M)	$14.3
U.S. HF Revenue Units	457
Europe Revenue ($M)	$1.0
Europe Units	41

Segment trajectory (prior two quarters)

Metric	Q2 2024	Q3 2024	Q4 2024
U.S. Revenue ($M)	$10.7	$12.3	$14.4
U.S. HF Revenue ($M)	$10.5	$12.2	$14.3
U.S. HF Units	339	391	457
Europe Revenue ($M)	$1.1	$1.1	$1.0
Europe Units	63	56	41

KPIs and balance sheet

KPI	Q2 2024	Q3 2024	Q4 2024
Active Implanting Centers (U.S.)	189	208	223
U.S. Sales Territories	42	45	48
Cash & Cash Equivalents ($M)	$70.4	$100.2	$105.9
Long-term Debt ($M)	$29.3	$49.2	$49.3

Why: Management attributes Q4 growth to territory expansion, new accounts, and increased physician/patient awareness; gross margin compression stemmed from higher cost per unit; SG&A growth reflects headcount and SBC; interest expense rose with higher term-loan borrowings .

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Total Revenue	FY 2025	$63.0M–$65.0M (Jan 13, 2025)	$63.0M–$65.0M (Feb 4, 2025)	Maintained
Gross Margin	FY 2025	83%–84% (Jan 13, 2025)	83%–84% (Feb 4, 2025)	Maintained
Operating Expenses	FY 2025	$100.0M–$104.0M (Jan 13, 2025)	$100.0M–$104.0M (Feb 4, 2025)	Maintained
Total Revenue	Q1 2025	$14.5M–$15.0M (Jan 13, 2025)	$14.5M–$15.0M (Feb 4, 2025)	Maintained

Call context: 2025 guidance assumes ASPs roughly consistent with 2024 (~$31k/device U.S. HF), high‑single‑digit to low‑double‑digit net new active centers per quarter, and utilization returning to Q4 levels after seasonal Q1 dip .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q2 2024, Q3 2024)	Current Period (Q4 2024)	Trend
Reimbursement (OPPS/IPPS)	Anticipated inpatient DRG increase; advocating OPPS outcome; later confirmed IPPS DRG ~$43k; OPPS process ongoing	OPPS for 2025 maintained at APC 1580 (~$45k) and inpatient DRG reassigned to ~$43k; equalization supports access	Positive, stabilized access
CPT Category I codes	AMA accepted Category I CPT codes, effective Jan 1, 2026	Category I codes expected to streamline prior authorization and broaden access; RVUs visibility expected in July	Structural tailwind building into 2026
Commercial execution, salesforce	Leadership hires; focus on deeper adoption; fewer new centers near term	Compensation redesigned to reward program depth; inclusive rollout; strong reception and retention	Execution improving
Utilization per center	Focus shifting from new adds to deeper utilization	Record units/center in Q4; targeting “North Star” accounts with multiple champions and implanters	Utilization rising
Europe	Stable to modest; spend calibrated	One territory reduced; Europe revenue flat; continuing disciplined OUS investment	Flat to cautious
Cash burn cadence	Added liquidity (debt/ATM); flexibility to invest	Seasonal cash burn step-up in Q1, then decline through year; FY25 burn expected lower YoY	Improving trajectory

Management Commentary

“We capped off a very strong 2024… focused on three key strategic priorities to drive Barostim toward becoming the standard of care – building a world‑class sales organization, supporting the development of sustainable Barostim programs… and addressing barriers to adoption.” – Kevin Hykes, CEO .
“CMS maintained Barostim in the new technology APC 1580 for 2025… On an inpatient basis, we successfully secured the reassignment of Barostim to DRG 276… approximately $43,000… effectively equalized between inpatient and outpatient settings.” – Kevin Hykes .
“For 2025, we’re focused on 3 key strategic priorities… a new compensation structure that rewards the key elements of a successful program… targeting centers with the highest potential… and a steady cadence of publications and real‑world evidence.” – Kevin Hykes .

Q&A Highlights

2025 guidance mechanics: Base ASP ~$31k in U.S. HF; net new centers high single digit to low double digit per quarter; utilization dips seasonally in Q1 then returns to Q4 levels .
OpEx framework: 2024 OpEx just over $102M included ~$8.4M one‑time option modification in Q1; 2025 OpEx growth concentrated in sales & marketing as territories expand ~3 per quarter .
Sales comp plan: Inclusive rollout with program‑related accelerators to deepen adoption (consistency, diversified referral sources, redundant surgical partners) and strong field reception .
Site‑of‑service: No material shift yet to inpatient post‑DRG change; will monitor CMS data; OUS territories reduced due to ROI .
“North Star” account construct: multiple HF prescribers, diversified referrers, multiple implanters, and admin partner; comp plan pays more where program elements exist .
Cash burn: Step-up in Q1 from bonuses/one‑timers; declining sequentially thereafter; 2025 annual burn expected down YoY .

Estimates Context

We attempted to pull S&P Global consensus EPS and revenue for Q4 2024 and Q1 2025 but the data were unavailable due to temporary request limits. As a result, we cannot definitively state beat/miss versus consensus for Q4 2024 at this time. We can update this section when access is restored.

Key Takeaways for Investors

Strong U.S. HF momentum with accelerating unit growth and record units per center in Q4 suggests deepening adoption as program‑focused selling takes hold .
Reimbursement tailwinds into 2025 are meaningful: OPPS maintained (~~$45k) and IPPS reassigned (~~$43k), reducing economic friction across sites of service and supporting volume scalability .
FY25 guide (23–27% growth) was reiterated; management expects Q1 seasonality then steady quarterly growth—watch utilization per center and net new AICs as leading indicators .
Operating leverage is progressing, but SG&A intensity remains elevated to build programs; monitor OpEx trajectory versus revenue as 48 territories ramp through 2025 .
Europe remains a modest contributor; disciplined OUS investment prioritizes ROI while U.S. drives growth .
Structural catalysts: Category I CPT codes (effective Jan 1, 2026) should streamline prior auth and broaden payer coverage; initial RVU view expected mid‑year 2025 .
Liquidity looks adequate (cash $105.9M) with debt in place; management expects lower FY25 cash burn; track progress against quarterly burn cadence .

Appendix: Source Documents (Q4 2024)

8‑K and press release with full financials and 2025/Q1’25 guidance .
Q4 2024 earnings call transcript (prepared remarks and Q&A) –.
Prior quarters for trend: Q3’24 release/transcript – –; Q2’24 release/transcript – –.
Reimbursement updates: OPPS final rule (APC 1580) ; CPT Category I codes acceptance .
Additional RWE: post‑quarter conference (THT) real‑world data on reduced hospital utilization .

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