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MI

MYOMO, INC. (MYO)·Q4 2024 Earnings Summary

Executive Summary

  • Q4 2024 delivered record revenue of $12.1M (+154% y/y) on 220 revenue units (+106%), 71.4% gross margin (+610 bps y/y), and first-ever positive quarterly operating cash flow ($3.4M); Adjusted EBITDA turned positive at $0.17M while GAAP EPS improved to $(0.01) .
  • Mix/operations: Medicare Part B drove 57% of revenue; direct billing channel rose to 81% of revenue; international revenue was a record ~$1.5M; O&P channel revenue reached $0.6M (up 94% q/q) as 160 CPOs were trained .
  • 2025 outlook introduced: Q1 revenue guided to $9.0–$9.5M (seasonal), FY 2025 revenue to $50–$53M (54–63% growth y/y), with H2-weighted profile as higher advertising spend (> $6M) seeds pipeline; management targets return to positive operating cash flow by Q4 2025 .
  • Execution momentum: backlog of 272 (+18% y/y) and a record 657 pipeline adds (+72% y/y) support continued growth; management highlighted payer-contract progress (now ~18.6M lives) and stable Medicare Part B reimbursement, while Medicare Advantage denials remain a headwind .
  • Estimates: Wall Street consensus from S&P Global was not retrievable at this time; relative to prior company guidance (Q3), Q4 revenue of $12.1M beat the prior $9.5–$10.5M range, a positive surprise likely to support sentiment pending formal consensus comparisons . S&P Global estimates unavailable at time of request.

What Went Well and What Went Wrong

  • What Went Well
    • Record top-line and unit volume with margin expansion: revenue $12.1M (+154% y/y), 220 units (+106%), gross margin 71.4% (+610 bps), and first positive quarterly Adjusted EBITDA ($0.17M) and operating cash flow ($3.4M) .
    • Channel development and scale: direct billing rose to 81% of revenue; international revenue reached a record ~$1.5M (primarily Germany); O&P revenue $0.6M (+94% q/q) as ~160 CPOs trained; facility move increased capacity to 120 units/month and headcount to 190 .
    • CEO tone on execution: “transformational year,” rapid scaling to serve Medicare Part B population; objective to “repeat our success…in 2025” .
  • What Went Wrong
    • Medicare Advantage headwinds: continued first-time authorization denials and slow appeals; historical overturn rate 40–50% but timing has lengthened, elongating revenue cycle for MA/commercial payers .
    • ASP down slightly vs atypically high Q3; Q4 ASP ~$54.9K vs Q3 ~ $57.2K (including some supplemental payments), as mix and timing normalized; still +23% y/y in Q4 .
    • Operating expenses up 60% y/y to $8.9M to support growth (payroll, R&D, field clinical and reimbursement); 2025 OpEx expected above ~$10M/quarter near-term as the company scales, with cash burn expected in 1H and Q2 as peak .

Financial Results

MetricQ2 2024Q3 2024Q4 2024
Revenue ($M)$7.52 $9.21 $12.07
Gross Margin (%)70.8% 75.4% 71.4%
Net Loss ($M)$(1.12) $(0.97) $(0.26)
Diluted EPS ($)$(0.03) $(0.03) $(0.01)
Adjusted EBITDA ($M)$(1.17) $(0.58) $0.17
Revenue Units (qty)158 161 220
ASP ($)~52.7K–57.2K (context) ~57.2K ~54.9K
Medicare Part B Share (%)n/a55% 57%
Direct Billing Share (%)n/a65% 81%
International Revenue ($M)n/an/a~$1.5
O&P Revenue ($M)n/an/a$0.6

Notes:

  • Q3 ASP was elevated by supplemental payments; excluding those, Q3 ASP ≈ $52.7K (+23% y/y) . Q4 ASP ≈ $54.9K (+23% y/y) .
  • Cash from operations Q4: +$3.4M; FCF ≈ $2.5M; cash & short-term investments $24.9M at 12/31/24 .

KPIs and Funnel Metrics (Q4 2024 unless noted)

  • Pipeline adds: 657 (+72% y/y) .
  • Total pipeline: 1,389 (+33% y/y) .
  • Backlog: 272 (+18% y/y); includes 101 qualified Medicare Part B patients .
  • Cost per pipeline add: $1,224 in PR; CFO cited $1,226 on the call (minor rounding difference) .

Channel/Geography Mix

  • Direct billing: 81% of Q4 revenue .
  • International: ~$1.5M (≈12% of Q4 revenue), primarily Germany .
  • U.S. O&P: $0.6M in Q4, up 94% q/q .

Versus Prior Year and Prior Quarter

  • Revenue: +154% y/y and +31% q/q (from $9.21M in Q3) .
  • Gross margin: +610 bps y/y; down vs Q3 on mix/operational factors (still ~71%) .
  • EPS: improved to $(0.01) from $(0.07) y/y and $(0.03) q/q .

Against Estimates

  • S&P Global Wall Street consensus estimates were unavailable at time of retrieval; comparisons to consensus cannot be provided. Q4 revenue exceeded company’s prior guidance range of $9.5–$10.5M issued in Q3 . S&P Global estimates unavailable at time of request.

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
RevenueQ1 2025n/a$9.0–$9.5MNew
RevenueFY 2025n/a$50–$53M (+54–63% y/y)New
Gross MarginFY 2025 (modeling)n/a~70–71% (CFO commentary)Qualitative/Color
Advertising ExpenseFY 2025n/a>$6M (nearly doubled)New/Investment increase
Cash Flow from OpsFY 2025n/aNegative in Q1–Q3; target positive in Q4New
Capital ExpenditureFY 2025n/a≈$1M (due to final buildout)New

Additional context:

  • H2 2025 expected to be stronger as higher advertising spend converts pipeline to orders; patients sourced in H1 typically convert in H2 given 4–6 month cycle .
  • Payer contracts: signed/pending covering ~18.6M lives to support in-network traction (qualitative progress, not formal guidance) .

Earnings Call Themes & Trends

TopicPrevious Mentions (Q2 2024, Q3 2024)Current Period (Q4 2024)Trend
Medicare Part B reimbursementQ2: CMS fee schedule from April 1; revenue recognized at delivery; ASP uplift . Q3: Med B 55% of revenue; accelerated revenue recognition .Med B 57% of revenue; clearer reimbursement; prices increased 2.4% for 2025 .Improving clarity; sustained mix benefit.
O&P channel buildoutQ3: Launched O&P program at AOPA; began training .~160 CPOs trained; O&P revenue $0.6M in Q4 (+94% q/q); expect meaningful growth in 2H25 .Scaling; contribution ramps in 2H25.
International (Germany)Q3: Steady growth; no detailed split .Record ~$1.5M in Q4; >$4M FY; strong statutory coverage; expansion ongoing .Positive trajectory.
Capacity & hiringQ2/Q3: Building clinical/reimbursement capacity; preparing to support growth .New 35K sq. ft. facility; capacity 120 units/month; headcount 190; hiring continues .Capacity in place to scale.
Advertising & pipelineQ2: Cost per add $1,545; 550 adds; pipeline 1,179 . Q3: Cost per add $1,618; 645 adds; pipeline 1,263 .Cost per add $1,224–$1,226; 657 adds; pipeline 1,389; ad spend to >$6M in 2025 .More efficient; higher spend planned.
Gross margin outlookQ2: 70.8% . Q3: 75.4% .71.4%; CFO models ~70–71% for 2025 .Stable ~70–71% with mix factors.
Payer dynamicsQ2/Q3: Building access; timing and DSO impacted by transitions .MA denials persist; appeals slow; 5 new BCBS-type contracts; ~18.6M lives .Mixed: Med B strong; MA remains a hurdle.
Tariffs/supply chainLimited commentary prior.Minimal tariff impact; mostly US-sourced; Germany not currently impacted .Neutral risk currently.
R&D/next-genLimited prior disclosures.Investing in next-gen MyoPro; broaden indication/patient reach .Increasing investment.

Management Commentary

  • CEO: “2024 was a transformational year…we generated record financial and operating results by capitalizing upon market access for patients covered by Medicare Part B…we exited the year in the best position we've been in, and our objective is to repeat our success…in 2025.” .
  • CFO: “Adjusted EBITDA was about $200,000, a significant improvement compared with a negative $2.1 million for the fourth quarter of 2023…Cash…were $24.9 million…We believe our cash and cash equivalents are sufficient to fund our operations for at least the next 12 months.” .
  • Strategy: “Building out the O&P distribution channel is a critical part of our long-term strategy…we expect O&P-driven revenue to increase meaningfully in the second half of 2025.” .
  • 2025 plan: “We expect to nearly double our advertising expenses in 2025 to over $6 million…Patients obtained…are not expected to generate revenue until the second half of 2025…anticipate a return to positive operating cash flow by fourth quarter 2025.” .

Q&A Highlights

  • O&P channel contribution: FY24 O&P “a little over $1M”; majority of 2025 revenue still from direct provider; expect meaningful O&P growth in 2025 .
  • ASP and mix: Expect modest ASP uplift from CMS fee increase, partially offset by higher O&P mix in 2H25 .
  • Gross margin: Model ~70–71% for 2025 given facility overhead offset by ASP tailwind .
  • OpEx trajectory: Could be higher than ~$10M/quarter; “full year OpEx definitely starts with the fourth” (implying FY OpEx in the $40Ms) .
  • Reimbursement tone: 2025 viewed as consistent vs 2024; BCBS contracts should accelerate revenue cycles; MA may improve with regulatory scrutiny but remains a headwind .
  • Pipeline efficiency: Q4 cost per pipeline add cited at $1,226; management monitoring Meta/Facebook changes; expect possible uptick in Q1 cost per add .
  • Capex: ~ $1M in 2025 as final Burlington buildout completes .
  • Tariffs: Minimal impact expected; sourcing largely US-based; Germany not currently affected .

Estimates Context

  • S&P Global consensus estimates could not be retrieved at time of analysis; therefore, we cannot provide objective “vs. consensus” comparisons for revenue/EPS/EBITDA. S&P Global estimates unavailable at time of request.
  • Company-level benchmark: Q4 revenue of $12.1M exceeded the company’s prior guidance range of $9.5–$10.5M set on Nov 6, 2024, indicating stronger-than-anticipated conversion and mix .

Key Takeaways for Investors

  • Momentum building: Record Q4 revenue/units and first positive quarterly operating cash flow signal scale benefits from Medicare Part B and direct channel execution .
  • 2025 guide implies robust growth with H2 weighting: Q1 guided to $9.0–$9.5M; FY to $50–$53M; H1 investment (ads, hiring) likely depresses near-term cash flows before Q4 2025 positive FCF target .
  • Margin framework anchored ~70–71%: CFO commentary supports stable gross margins despite facility overhead and mix shifts; watch O&P mix impacts .
  • O&P channel is 2H25 catalyst: Training foundation laid (160 CPOs); sequential Q4 O&P revenue inflection; expect meaningful 2025 contribution, especially in H2 .
  • Payer dynamics: Med B strong/expanding; MA remains bottleneck—success in payer contracting (~18.6M lives) is key to cycle time and mix improvement .
  • International optionality: Germany delivering profitable growth and >$1M/quarter potential; continued expansion supports diversification .
  • Trading setup: Strong Q4 beat vs prior guide, positive cash flow inflection, and above-consensus-looking FY25 growth guide (pending consensus) are positive catalysts; near-term prints may reflect H1-seasonal softness and elevated OpEx before H2 acceleration .

Appendix: Additional Quantitative Detail

Channel/Backlog/Pipeline Metrics (Q4 2024)

  • Direct billing: 81% of revenue .
  • International: ~$1.5M (≈12% of revenue) .
  • O&P: $0.6M revenue in Q4 (+94% q/q) .
  • Backlog: 272 (+18% y/y); 233 Q4 authorizations/orders (+27% y/y); 101 Med B qualified .
  • Pipeline: 657 adds in Q4 (+72% y/y); total 1,389 (+33% y/y) .

Non-GAAP

  • Adjusted EBITDA definition: EBITDA adjusted for stock-based compensation and loss on equity investment; Q4 2024 Adjusted EBITDA $0.168M (vs $(2.071)M in Q4 2023) .