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SI

SI-BONE, Inc. (SIBN)·Q1 2025 Earnings Summary

Executive Summary

  • Q1 2025 delivered strong top-line and profitability progress: revenue $47.29M (+24.9% y/y), gross margin 79.7% (+80 bps y/y), and positive adjusted EBITDA $0.47M, with net loss improving to $6.54M (-40% y/y) .
  • Wall Street estimates were exceeded: revenue beat consensus (~$45.13M*) and EPS beat (-$0.22* vs actual -$0.15), continuing the beat from Q4 and reversing a slight revenue miss in Q3*.
  • Guidance raised at the upper end: FY25 revenue to $193.5–$197.5M (prior $193.5–$195.5M), FY25 gross margin lifted to 78% (prior 77–78%), OpEx growth ~10% (prior ~9%), with positive adjusted EBITDA expected for the full year .
  • Key catalysts: proposed CMS NTAP for iFuse TORQ TNT (~$3,960 add-on effective Oct 1, 2025), TPT for Granite outpatient, and CMS proposal to increase inpatient spinal fusion DRGs by ~8–9%, supporting pelvic fixation economics and adoption .

What Went Well and What Went Wrong

What Went Well

  • Broad-based growth with strong U.S. execution: U.S. revenue $44.8M (+26.6% y/y), driven by robust procedure demand and new product rollouts (INTRA, Granite 9.5, TNT) .
  • Margin expansion and operating leverage: gross margin 79.7% (+80 bps y/y) on mix/ASP and supply chain efficiencies; revenue growth ~3x OpEx growth (7.8%) enabled positive adjusted EBITDA in a seasonally heavier cash-use quarter .
  • Physician engagement inflecting: record >1,400 active U.S. physicians and +300 adds in the quarter (+27.3% y/y), with increasing cross-modality usage and territory productivity reaching ~$2M per territory; “Our momentum continues unabated…” – Laura Francis .

What Went Wrong

  • International remains modest: international revenue $2.5M vs $2.4M y/y; growth outside U.S. remains small relative to the business mix .
  • GAAP loss persists: net loss was $6.54M (EPS -$0.15), though improved materially from prior year; depreciation and growing surgical capacity will weigh on reported margins as the year progresses .
  • Seasonality and prudent stance temper guidance cadence: management assumes a 3–5% sequential decline in Q3 on normal seasonality and is maintaining the lower end of FY revenue guidance pending macro clarity .

Financial Results

Consolidated P&L and Margins

MetricQ3 2024Q4 2024Q1 2025
Revenue ($USD Millions)$40.34 $49.00 $47.29
Gross Profit ($USD Millions)$31.90 $38.78 $37.70
Gross Margin (%)~79% ~79% 79.7%
Total Operating Expenses ($USD Millions)$39.54 $44.27 $45.18
Operating Loss ($USD Millions)$(7.63) $(5.49) $(7.48)
Net Loss ($USD Millions)$(6.58) $(4.50) $(6.54)
Diluted EPS ($)$(0.16) $(0.11) $(0.15)
Adjusted EBITDA ($USD Millions)$(0.24) $1.86 $0.47

Segment Revenue

SegmentQ3 2024Q4 2024Q1 2025
U.S. Revenue ($USD Millions)$38.3 $46.9 $44.8
International Revenue ($USD Millions)$2.1 $2.1 $2.5

KPIs and Operating Metrics

KPIQ3 2024Q4 2024Q1 2025
Active U.S. Physicians (#)>1,200 ~1,400 >1,400; +300 adds (+27.3% y/y)
Territories (U.S.)——85 territories
Territory Productivity (Trailing 12M)——~$2.0M
Cash & Equivalents ($USD Millions)$150.8 $150.0 $144.4
Net Cash Usage ($USD Millions)$0.7 $0.8 $5.6 (seasonal; -31.7% y/y)

Actual vs Consensus (Performance vs Estimates)

MetricQ3 2024Q4 2024Q1 2025
Revenue – Actual ($USD Millions)$40.34 $49.00 $47.29
Revenue – Consensus ($USD Millions)$40.49*$48.87*$45.13*
EPS – Actual ($)$(0.16) $(0.11) $(0.15)
EPS – Consensus ($)$(0.239)*$(0.134)*$(0.218)*

Values retrieved from S&P Global.*

Guidance Changes

MetricPeriodPrevious Guidance (Feb 24, 2025)Current Guidance (May 5, 2025)Change
Revenue ($USD Millions)FY 2025$193.5–$195.5; ~16–17% y/y growth $193.5–$197.5; ~16–18% y/y growth Raised upper end
Gross Margin (%)FY 202577–78% 78% Raised midpoint
Operating ExpensesFY 2025~9% growth at revenue midpoint ~10% growth at revenue midpoint Raised
Adjusted EBITDAFY 2025Positive (2H and FY) Positive (FY) Maintained
Tariff Impact (GM)FY 2025Not specifiedNo material GM impact expected Clarified minimal impact

Earnings Call Themes & Trends

TopicPrevious Mentions (Q3 2024 and Q4 2024)Current Period (Q1 2025)Trend
Product performance (Granite 9.5, TORQ TNT, INTRA)Granite 9.5 and TNT introduced; strong interest; record physicians and near AEBITDA breakeven Broad-based demand; Granite 9.5 cases with 4 implants +~69% y/y; TNT adoption ahead of plan; INTRA supports interventionalists Accelerating adoption
Reimbursement tailwindsTPT approved for Granite outpatient; TNT launched Proposed NTAP for TNT (~$3,960); CMS DRGs +8–9% proposal for spinal fusion; Granite reassignment under review Improving economics
Supply chain/ASP/marginsMargin uplift vs prior year; inventory reserve impacted Q4’23 GM +80 bps; ASP uplift from mix (4-implant Granite); efficiencies; expect depreciation headwinds later Structural margin tailwinds with prudent outlook
Physician engagement and densityActive physicians grew to ~1,200+; strong engagement >1,400 active; +300 adds; more multi-procedure physicians (+~43%); avg ~5 procedures among repeat performers (+30% to overall) Strong user growth and density
Macro/seasonalityGuided to AEBITDA positive Q4; prudence on FY25 cadence Assume Q3 sequential -3% to -5%; maintain lower-end revenue guide for prudence amid macro; less tariff risk Thoughtful cadence; resilient demand
R&D pipeline and breakthroughsThird Breakthrough Device Designation announced New SI joint solution targeted for Q1 2026; third BDD implant in development targeting major spine need Pipeline visibility improving

Management Commentary

  • “We delivered another quarter of stellar revenue growth, expanded our gross margins and exceeded profitability targets.” — Laura Francis, CEO .
  • “Our worldwide revenue was $47.3 million... enabled us to deliver positive adjusted EBITDA.” — Laura Francis .
  • “The 80-basis points improvement [in GM] ... better-than-expected ASP [mix of 4-implant Granite cases] and supply chain efficiencies.” — Anshul Maheshwari, CFO .
  • “We currently do not anticipate any material impact on gross margins or our supply chain from the proposed tariffs.” — Anshul Maheshwari .
  • “We are updating our full year revenue guidance to $193.5–$197.5 million... and expect full year gross margin to be 78%.” — Anshul Maheshwari .

Q&A Highlights

  • Growth drivers: Broad-based adoption across SI joint fusion, pelvic fixation, and trauma; Laura emphasized new products from 2024 (INTRA, Granite 9.5, TNT) contributing to accelerating growth, while declining to provide product-level revenue splits .
  • Gross margin trajectory: Q1 strength came from ASP/mix and efficiencies; outlook embeds potential ASP moderation and depreciation, with upside possible if 4-implant Granite case mix rises further .
  • Cadence and seasonality: Management assumes typical Q3 seasonality (-3% to -5% q/q) and maintained lower-end FY revenue guide to account for macro uncertainty despite strong execution .
  • OpEx growth drivers: FY25 OpEx ~10% reflects elevated R&D for two products, higher commissions on revenue growth, and higher G&A vs Q1 run-rate .
  • Market development: TAM expansion and physician funnel strategy; interventionalists additively engage SI procedures; record adds and increasing multi-procedure usage support sustained growth .

Estimates Context

  • Q1 2025 beat: revenue $47.29M vs ~$45.13M* consensus; EPS -$0.15 vs -$0.218* consensus.
  • Q4 2024 beat: revenue $49.00M vs ~$48.87M* consensus; EPS -$0.11 vs -$0.134* consensus.
  • Q3 2024 mixed: slight revenue miss $40.34M vs ~$40.49M* consensus, while EPS beat -$0.16 vs -$0.239* consensus.

Values retrieved from S&P Global.*

Key Takeaways for Investors

  • Strong execution with successive quarterly profitability progression (AEBITDA positive back-to-back), supported by margin expansion and operating discipline .
  • Reimbursement tailwinds (NTAP for TNT; TPT for Granite; CMS DRG proposal) are likely to support ASP/mix and procedure economics, particularly in pelvic fixation and trauma .
  • Physician growth and density are key structural drivers; record adds and multi-procedure adoption should sustain double-digit volume growth and support mix/ASP .
  • FY25 guidance prudence leaves room for upward revision if macro holds and mix benefits persist; watch Q3 seasonality and depreciation effects on GM .
  • Pipeline visibility improves the medium-term thesis: Q1 2026 SI joint solution and third BDD device broaden the portfolio and call points, enhancing growth durability .
  • Near-term trading implications: Evidence of consistent beats, raised gross margin guidance, and favorable CMS proposals are positive catalysts; monitor confirmation of NTAP finalization and DRG changes .
  • Cash profile improving with lower net cash usage and path to FCF in 2026; leverage likely continues as revenue growth outpaces OpEx .