Lucid Diagnostics Inc. (LUCD)·Q4 2024 Earnings Summary

Executive Summary

• Q4 2024 revenue was $1.20M (up 15% YoY), with a record 4,042 EsoGuard tests processed (+45% QoQ, +84% YoY); GAAP EPS was $(0.20) and non-GAAP adjusted loss/share was $(0.19) .
• Versus Street: revenue missed consensus ($1.42M*) while EPS was in line at $(0.19*); management attributed revenue variance to cash-collection accounting and elongated payer timelines (ASC 606 variable consideration) .
• Payer and evidence catalysts advanced: first commercial coverage (Highmark BCBS NY), first biomarker-law coverage agreement (BCBS Rhode Island), NCCN guideline update referencing non-endoscopic biomarker testing such as EsoGuard, and MolDX reconsideration filed with decision targeted for 1H 2025 .
• Liquidity improved: cash was $22.4M at 12/31/24; pro forma cash ~$37M after March financing; “baby shelf” limitation lifted to ~$70M of financing optionality, and 5-year convertible note in place (12% interest, $1 conversion) .

What Went Well and What Went Wrong

What Went Well

• Record operational throughput: “Processed a single-quarter record of 4,042 EsoGuard tests in 4Q24, a 45% sequential increase and 84% annual increase” .
• Commercial coverage milestones: first positive coverage policy (Highmark BCBS) and first payment under state biomarker legislation (BCBS Rhode Island), which management views as precedent-setting for broader coverage .
• Concierge medicine channel traction: >20 cash‑pay concierge contracts signed within weeks of launch; management expects these contractually-guaranteed revenues to contribute in 2H 2025 .
• Management tone: “We believe we are on the cusp of achieving broader payor coverage for EsoGuard…well positioned to capitalize on EsoGuard’s very large clinical and market opportunity” (CEO) .
• Evidence and guideline catalysts: NCCN now includes a section on esophageal precancer screening aligning with society guidelines that permit non-endoscopic biomarker testing; CLUE and ENVET-BE clinical utility studies accepted for publication .

What Went Wrong

• Revenue miss vs Street despite record volumes: actual $1.20M vs $1.42M* consensus; management cited cash-collection accounting, elongated payment timelines, and out-of-network status as key drivers .
• Effective ASP optics: quarter’s implied ASP looked low (~$300/test) due to timing of cash receipts; allowable amounts where paid remained Medicare rate ($1,600/test), but lags and denials masked this in reported revenue .
• Operating cost intensity: operating expenses rose to ~$13.6M (vs $12.9M in Q3), contributing to GAAP net loss of $(11.5)M; non‑GAAP OpEx was $12.1M .
• Denials and adjudication headwinds: of adjudicated claims, ~35% resulted in an allowable payment; denials included ~30% “not medically necessary/prior auth required” and ~27% “non-covered” .

Financial Results

Estimates vs Actuals (Q4 2024)

• Consensus details: EPS estimates = 5; Revenue estimates = 6 (Q4 2024)*.
• Values marked with * retrieved from S&P Global.

KPIs

Q4 Operational Metrics (selected)

• Concierge medicine contracts: >20 signed within weeks of launch .
• Allowed amount where paid: ~$1,600/test (near Medicare rate) .
• Claims flow: ~80% adjudicated, ~20% pending; ~35% allowable; ~30% denials “not medically necessary/prior auth required”; ~27% “non-covered” .
• Backlog of claims under work: >$15M .
• Cash & equivalents: $22.4M at 12/31/24; ~ $36.9–$37M pro forma including March financing .

Segment breakdown: Not applicable; company reports a single operating focus (EsoGuard/EsoCheck) .

Guidance Changes

Earnings Call Themes & Trends

Management Commentary

• “We believe we are on the cusp of achieving broader payor coverage for EsoGuard and expect our focus on new contractually‑guaranteed revenue sales channels, including concierge medicine, to drive revenue growth in the second half of 2025.” – Lishan Aklog, MD, Chairman & CEO .
• “With a positive [Medicare] policy, we would shift that element of the test volume to recognizing [revenue] when the report is issued…with a 90% margin and a $2,000 price point…the speed of collection…shouldn’t change burn rate significantly.” – Dennis McGrath, CFO .
• “We’ve already signed 20 concierge medicine contracts…our expectation…is that [concierge and direct contracting] will start making an impact on our revenue starting in the second half of this year.” – CEO .

Q&A Highlights

• Focus shifting from volume to revenue: management urged investors to prioritize revenue trajectory given revenue‑generating channels (concierge, direct contracting) over simply extrapolating 4,000×4 volumes for 2025 .
• ASP optics and timing: effective ASP looked low due to cash-collection accounting; allowable amounts where paid remain around the Medicare rate (~$1,600/test), with elongated timelines until in‑network status improves .
• Medicare catalyst: upon draft LCD in 1H 2025, Lucid plans to target Medicare‑dense geographies and can submit up to a one‑year backlog of Medicare claims once final/effective .
• TAM expansion: NIH‑funded study in non‑GERD at‑risk patients could expand the addressable market by up to ~20M patients over time (AGA already allows risk‑factor–based screening without symptomatic GERD) .
• Burn-rate ambition: with concierge ramp (and Medicare), management aims to potentially halve burn by year‑end 2025 .

Estimates Context

• Q4 2024: revenue $1.197M vs consensus $1.424M* (miss); EPS $(0.20) vs $(0.19)* (in line/slight miss). EPS estimates (n=5); Revenue estimates (n=6)*. Reported revenue reflects cash collections under ASC 606 variable consideration; elongated out‑of‑network payment cycles and denial rates contributed to variance despite record test volumes .
• Outlook for estimate revisions: Street may trim near‑term revenue until contracted/concierge revenue starts to flow (2H 2025) and/or Medicare coverage accelerates recognition; EPS sensitivity will track OpEx discipline and revenue ramp .
• Values marked with * retrieved from S&P Global.

Key Takeaways for Investors

• Coverage catalysts are lining up: MolDX draft LCD flipping to coverage in 1H 2025 would materially improve cash flow timing and revenue recognition; first commercial policy (Highmark) and biomarker‑law payment (BCBS RI) are important precedents .
• Near‑term revenue mix shift: >20 concierge contracts and a growing direct‑contracting pipeline should begin contributing in 2H 2025 with contractually‑guaranteed payments, potentially lifting effective ASP and smoothing collections .
• Liquidity runway strengthened: ~$37M pro forma cash, a 5‑year convertible note, and ~$70M shelf capacity provide flexibility through key reimbursement milestones .
• Watch the conversion from volume to dollars: record 4,042 tests confirms demand, but out‑of‑network dynamics and denials constrain near‑term revenue; improving coverage and contracted channels are the unlocks .
• Operating discipline required: Q4 OpEx increased QoQ; management aims to reduce burn (target up to ~50% in 2H 2025) as higher‑margin cash‑pay revenue ramps and Medicare coverage improves collections .
• Evidence/guidelines momentum supports payer adoption: NCCN screening inclusion, new CLUE/ENVET publications, and NIH grant build payer confidence and long‑term TAM expansion potential .
• Trading setup: stock likely sensitive to MolDX draft LCD timing/outcome, additional commercial coverage wins, and early concierge revenue prints; each is a potential catalyst for estimate and narrative shifts .

Values marked with * retrieved from S&P Global.