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Lucid Diagnostics Inc. (LUCD)·Q1 2025 Earnings Summary

Executive Summary

  • Q1 2025 revenue was $0.83M, down sequentially and year over year, driven by delayed collections (UnitedHealthcare DEX Z-Code rollout) and claim denials at Kaiser; GAAP EPS was $(0.52) and non-GAAP adjusted EPS was $(0.16) .
  • Against Wall Street consensus, LUCD missed revenue ($0.83M vs $1.28M*) and was roughly in line on non-GAAP EPS (actual $(0.16) vs $(0.158)); 5 EPS estimates and 6 revenue estimates contributed to consensus.
  • Management reiterated confidence in imminent Medicare MolDX coverage and highlighted expanding cash-pay concierge medicine and employer contracts expected to begin driving contractually-guaranteed revenue in 2H25 .
  • Balance sheet strengthened with pro forma cash >$40M entering Q2 (March 31 cash $25.2M plus April financing $16.1M), extending runway well into 2026 and past reimbursement milestones .

What Went Well and What Went Wrong

  • What Went Well

    • “We are now better positioned than ever to capitalize on EsoGuard's significant clinical and commercial opportunity,” with 3,034 tests processed and strategic progress in concierge and employer channels .
    • First positive commercial coverage policy from Highmark Blue Cross Blue Shield, plus NCCN guideline update referencing non-endoscopic biomarker testing like EsoGuard as acceptable alternative to endoscopy—important precedents for payer discussions .
    • Pro forma cash runway extended well into 2026 following equity offerings, enabling aggressive commercialization post-Medicare decision .

  • What Went Wrong

    • Revenue recognition constrained by delayed collections: UnitedHealthcare’s national DEX Z‑Code rollout delayed claim processing; Kaiser claims saw denials resulting in zero collections in the quarter .
    • Effective ASP declined sequentially given mix shift to large health events and reimbursement timing; concierge contributions were minimal in Q1 due to early stage ramp .
    • Operating expenses rose to $13.3M (incl. $1.0M SBC), and GAAP net loss attributable to common stockholders was ~$36.0M, reflecting non-cash items (convertible debt fair value change) .

Financial Results

  • Core metrics vs prior periods and consensus
MetricQ3 2024Q4 2024Q1 2025Q1 2025 Consensus
Revenue ($USD Millions)$1.20 $1.20 $0.83 $1.28*
GAAP Diluted EPS ($USD)$(0.25) $(0.20) $(0.52) n/a
Non-GAAP Adjusted Loss ($USD Millions)$10.10 $10.88 $11.16 n/a
Non-GAAP Adjusted EPS ($USD)$(0.20) $(0.19) $(0.16) $(0.158)*
Total Operating Expenses ($USD Millions)$12.90 $13.57 $13.32 n/a
Cash & Equivalents ($USD Millions)$14.50 $22.40 $25.20 n/a
  • KPIs and operational metrics
KPIQ3 2024Q4 2024Q1 2025
EsoGuard Tests Processed (units)2,787 4,042 3,034
Invoiced Amounts (Pro Forma, $USD Millions)~$7.0 ~$10.0 >$7.5
Collections Recognized as Revenue ($USD Millions)$1.20 $1.20 $0.80
Median Allowable per Test ($USD)~$1,600–$1,938 range ~$1,600 $1,938.01 (Medicare rate median)

Values marked with * retrieved from S&P Global.

Guidance Changes

  • No formal quantitative guidance was issued. Management expects concierge medicine and employer channels to begin driving contractually-guaranteed revenue in 2H25 and plans to accelerate commercialization upon Medicare coverage .
MetricPeriodPrevious GuidanceCurrent GuidanceChange
Revenue – Contracted Channels2H 2025n/aExpected to begin driving contractually-guaranteed revenue New qualitative indication
Medicare Coverage (MolDX LCD)2025 (H1 draft expectation)n/aDraft LCD decision viewed as imminent; public comment then finalization New qualitative milestone

Earnings Call Themes & Trends

TopicQ3 2024 (Prev. Mentions)Q4 2024 (Prev. Mentions)Q1 2025 (Current)Trend
Medicare MolDX CoverageSubmission preparation; multiple MolDX meetings Expect first-half draft LCD; gateway to commercial payers “Imminent” draft LCD; ready to accelerate on Medicare population Positive momentum
Concierge Medicine (Cash-Pay)Strategy launched; senior hires from GRAIL >20 contracts signed; pricing around $2,500 list Doubled contracts in 6 weeks; patient materials/process build-out Scaling up
Employer & Fire Dept. ContractsEmphasis on contracted CYFT events Larger employers targeted; visibility robust Pipeline strong; lumpy events, focus on guaranteed payment Expanding
Clinical Evidence & GuidelinesBE‑1 validation accepted; strong package NCCN adds BE screening referencing non-endoscopic tests NCI-sponsored study supports expanded indication (no GERD); NIH $8M grant Strengthening
Reimbursement OperationsVariable consideration per ASC 606; allowables near Medicare Allowable avg ~$1,600; long collection tails United DEX Z‑Code delays; Kaiser denials; median at Medicare rate Operational headwinds but stabilizing allowables

Management Commentary

  • Strategy and positioning: “We are now better positioned than ever to capitalize on EsoGuard’s significant clinical and commercial opportunity... With additional capital secured, we have extended our operational runway well beyond key upcoming reimbursement milestones, including Medicare” .
  • Commercial approach: Focus on concierge and employer channels to drive revenue while pursuing broader coverage; “We continue to expect an impact on revenue from this effort in the second half of this year” .
  • Medicare outlook: “We really remain optimistic about the outcome... we believe this is imminent” regarding draft LCD coverage .
  • Collections dynamics: CFO detailed Z‑Code delays and Kaiser denials impacting Q1 collections and ASP mix; median allowable at the Medicare rate .

Q&A Highlights

  • Volumes and mix: Q1 tests at upper-end of 2,500–3,000 target; revenue lumpiness tied to large health events; no material weather impact .
  • ASP and collections: Concierge impact minimal in Q1; United DEX Z‑Code delays cut collection rate (10% vs prior 32%); Kaiser contributed $1.3M billables with zero collections .
  • Medicare mix: Backlog ~$19M (last 12 months ~$15M); current Medicare mix 12–15% with goal to reach ~40% post-coverage .
  • Contingency planning: Parallel build-out of cash-pay and contracted channels; extended runway mitigates timing risk .
  • Health system partnership: Comprehensive program across GI, primary care, and concierge within a major system; template for future rollouts .

Estimates Context

  • Q1 2025 vs S&P Global consensus: Revenue missed ($0.83M vs $1.28M*), reflecting delayed claim processing and denials; non-GAAP EPS roughly matched (actual $(0.16) vs $(0.158)*).
MetricQ1 2025 ActualQ1 2025 ConsensusSurprise
Revenue ($USD Millions)$0.83 $1.28*Miss
Non-GAAP EPS ($USD)$(0.16) $(0.158)*In line

Values marked with * retrieved from S&P Global.

Key Takeaways for Investors

  • Near-term catalyst: A draft MolDX LCD flipping EsoGuard from non-coverage to coverage is described as imminent; expect formal comment period then finalization—potential inflection for revenue recognition and cash conversion .
  • Revenue drivers shift in 2H 2025: Contracted concierge and employer channels should begin contributing more predictable, up-front revenue as materials/processes mature .
  • Operational headwinds explain Q1 miss: United DEX Z‑Code rollout and Kaiser denials depressed collections; allowables remain near Medicare rate, indicating pricing integrity .
  • Strong liquidity to execute: Pro forma cash >$40M post-April financing, extending runway well into 2026 to fund sales expansion upon Medicare coverage .
  • Payer precedents building: Highmark BCBS (NY) positive policy and NCCN guideline update strengthen case for broader commercial coverage post-Medicare .
  • Tactical focus on Medicare population: After coverage, management plans to pivot resources to geographies with high Medicare penetration and submit up to a one-year backlog of claims .
  • Trading implications: Stock likely to react to MolDX draft timing and evidence of contracted revenue ramp; monitor updates on United/Kaiser processing and additional regional coverage wins .

References: Q1 2025 press release and 8‑K ; Q1 2025 call transcript ; Q4 2024 release and call ; Q3 2024 call and release ; NCCN update ; Highmark BCBS coverage .

Values marked with * retrieved from S&P Global.