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SI

SI-BONE, Inc. (SIBN)·Q2 2025 Earnings Summary

Executive Summary

  • Q2 2025 delivered worldwide revenue of $48.6M (+21.7% YoY), gross margin of 79.8% (+80 bps YoY), diluted EPS of -$0.14, and positive adjusted EBITDA of $1.0M; cash and equivalents were $145.5M with $1.1M net cash generated, reaching cash flow breakeven in the quarter .
  • The company raised FY25 guidance: revenue to $195–$198M (from $193.5–$197.5M) and gross margin to 78.5–79.0% (from 78%); expects OpEx growth ~10% and positive adjusted EBITDA for FY25 .
  • Consensus vs actual: Q2 revenue beat by ~$0.5M ($48.12M cons. vs $48.63M actual) and EPS beat by ~$$0.04 (-$0.178 cons. vs -$0.14 actual) — both positive surprises; Q1 also beat revenue and EPS, while Q4 slightly beat revenue and EPS as well (values marked with asterisks; see Estimates Context for detail; Values retrieved from S&P Global)*.
  • Structural catalysts: CMS finalized NTAP for iFuse TORQ TNT effective Oct 1, 2025 (up to ~$4,136 add-on), proposed continuation of Granite’s TPT into CY2026, and the European launch of TORQ; sales execution remains strong with 1,440 active U.S. physicians (+25% YoY) and TTM revenue per territory at ~$2.1M (+~23%) .

What Went Well and What Went Wrong

What Went Well

  • Robust U.S. growth: U.S. revenue rose 22.8% to $46.4M on ~25% procedure volume growth; worldwide revenue grew 21.7% to $48.6M .
  • Profitability and cash flow: Third consecutive quarter of positive adjusted EBITDA ($1.0M) and achieved cash flow breakeven with $1.1M net cash generated; gross margin expanded to 79.8% (+80 bps YoY) .
  • Strategic momentum and physician engagement: Active U.S. physicians reached 1,440 (+25% YoY) and TTM revenue per territory hit $2.1M (+~23%); management emphasized “asset-light model and disciplined execution” supporting sustainable growth .
    • “We delivered double-digit procedure volume growth across all our U.S. target markets … and achievement of cash flow breakeven this quarter underscore the power of our asset-light model and disciplined execution.” — CEO Laura Francis .

What Went Wrong

  • Pricing/mix pressure: Management reiterated assumptions for low-single-digit ASP decline (~3–4%) in the back half, driven by procedure mix and depreciation related to new capacity and systems .
  • Operating expenses elevated: OpEx rose ~10% YoY to $45.8M on growth investments, higher commissions, and elevated G&A .
  • International softness/timing: International revenue was flat at $2.2M; Europe’s TORQ clearance came later than expected, pushing training/revenue impact into H2 and 2026 .

Financial Results

Key P&L and Cash Metrics

MetricQ4 2024Q1 2025Q2 2025
Revenue ($USD Millions)$49.002 $47.290 $48.630
Gross Margin %~79% 79.7% 79.8%
Operating Expenses ($USD Millions)$44.271 $45.175 $45.811
Operating Loss ($USD Millions)$(5.494) $(7.480) $(7.004)
Net Loss ($USD Millions)$(4.496) $(6.542) $(6.152)
Diluted EPS ($USD)$(0.11) $(0.15) $(0.14)
Adjusted EBITDA ($USD Millions)$1.864 $0.469 $1.020
Cash & Equivalents ($USD Millions)$150.0 $144.4 $145.5

Revenue by Geography

MetricQ4 2024Q1 2025Q2 2025
U.S. Revenue ($USD Millions)$46.9 $44.8 $46.4
International Revenue ($USD Millions)$2.1 $2.5 $2.2
Total Revenue ($USD Millions)$49.0 $47.3 $48.6

Operating KPIs

KPIQ4 2024Q1 2025Q2 2025
Active U.S. Physicians (#)~1,400 >1,400; +300 added 1,440 (+25% YoY)
TTM Revenue per Territory ($USD Millions)$1.8 ~$2.0 ~$2.1 (+~23% YoY)
U.S. Territories (Managers)87 territory managers 85 territories 85 territories
Adjusted EBITDA ($USD Millions)$1.864 $0.469 $1.020
Cash & Equivalents ($USD Millions)$150.0 $144.4 $145.5; Net cash generated $1.1M

Consensus vs Actual (Revenue and EPS)

MetricQ4 2024Q1 2025Q2 2025
Revenue Consensus Mean ($USD)$48.868M*$45.131M*$48.120M*
Revenue Actual ($USD)$49.002M $47.290M $48.630M
Rev Beat/(Miss) ($USD)+$0.134M*+$2.159M*+$0.510M*
Primary EPS Consensus Mean ($USD)-$0.13429*-$0.2175*-$0.1775*
Diluted EPS Actual ($USD)-$0.11 -$0.15 -$0.14
EPS Beat/(Miss) ($USD)+$0.02429*+$0.0675*+$0.0375*

Values retrieved from S&P Global.*

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
Revenue ($USD Millions)FY 2025$193.5–$197.5 (~16–18% YoY) $195–$198 (~17–18% YoY) Raised
Gross Margin %FY 202578% 78.5–79.0% Raised
Operating ExpensesFY 2025~10% growth at rev midpoint ~10% growth at rev midpoint Maintained
Adjusted EBITDAFY 2025Positive Positive Maintained
Seasonality cadenceH2 2025Not specifiedQ3 sequential decline ~4% (seasonality), Q4 ramp New detail
Reimbursement catalystsCY/FY 2025–26TNT NTAP proposed ~$3,960 (May) TNT NTAP finalized up to ~$4,136 (effective 10/1/25); Granite TPT proposed continuation CY2026 Strengthened

Earnings Call Themes & Trends

TopicPrevious Mentions (Q4 2024, Q1 2025)Current Period (Q2 2025)Trend
Innovation/Product MomentumGranite 9.5 outpaced prior launches; TNT early adoption exceeded expectations; multiple disruptive products in pipeline including third BDD Broad-based demand across modalities; record TNT usage; SI joint solution submission soon; third BDD 510(k) planned in 2026 Accelerating
Physician Engagement & Density~1,400 active in Q4; +260 adds; multi-procedure physicians up ~40% 1,440 active; +25% YoY; double-digit growth across call points; maturation drives ~5 procedures/physician Improving
Commercial Model & Territory ProductivityHybrid model with agents boosted productivity to $1.8M; plan selective sales force expansion TTM territory revenue ~$2.1M (+~23%); maintain hybrid model; target ~100 territories in 12–18 months Improving
Reimbursement TailwindsGranite TPT ($0 device offset); pursuing DRG reassignment; TNT NTAP proposed 10/2025 TNT NTAP finalized (Oct 1, 2025, ~$4,136); Granite TPT continuation proposed; APC Level 7 outpatient proposal; CPT code flexibility Strengthening
Supply Chain/MarginsStreamlining supply chain supported ~79% GM in 2024; prudence on 2025 GM (77–78%) GM 79.8% in Q2; cautious H2 view with ASP/mix headwinds and depreciation; FY GM guide 78.5–79% Stable to slight pressure
Europe/InternationalNo major product launches in Europe since ~7 years TORQ launched in Europe; first cases done; 2026 growth driver; minimal near-term impact due to timing Emerging tailwind
Regulatory/LegalDOJ investigation acknowledged; no material updates No updates; continued cooperation Unchanged
Macro/TariffsLimited expected impact on SI-BONE procedures; materials largely domestic/Canada No change in commentary; focus on secular growth drivers Stable

Management Commentary

  • “We delivered double-digit procedure volume growth across all our U.S. target markets … consistent delivery of positive Adjusted EBITDA and achievement of cash flow breakeven this quarter underscore the power of our asset-light model and disciplined execution.” — CEO Laura Francis .
  • “Gross margin was 79.8%, expanding by 80 basis points year over year, driven by actions to improve manufacturing and supply chain efficiencies over the last twelve months.” — CFO Anshul Maheshwari .
  • “In June, we received regulatory approval to launch iFuse TORQ in Europe … we expect torque to accelerate adoption and growth across our international markets.” — CEO Laura Francis .
  • “We anticipate filing our 510(k) for this groundbreaking product sometime in 2026.” — CEO Laura Francis on third BDD device .
  • “Our trailing twelve month revenue per territory increased to $2,100,000 representing 23% growth over the comparable prior year period.” — CEO Laura Francis .

Q&A Highlights

  • Guidance cadence and seasonality: Management embeds ~4% Q3 sequential decline due to vacations/conferences with typical Q4 ramp; upside drivers include faster Granite adoption, better-than-assumed ASP, and TNT capacity with NTAP from Oct 1 .
  • Gross margin trajectory: FY guide lifted to 78.5–79.0%; ASP decline (~3–4%) and added depreciation for TNT capacity and systems headwinds; medium-term GM expected to stabilize around 76–77% as new products scale .
  • Interventional engagement: TORQ remains product of choice; INTRA adoption where CPT 27278 reimbursement is clearly defined; CMS proposed ~18% increase for in-office CPT 27278 .
  • Europe rollout: TORQ clearance later than expected; minimal near-term revenue impact; training in late Q3/Q4; Europe expected to accelerate in 2026 .
  • Commercial expansion: Target ~100 U.S. territories over ~15 months; hybrid model sustains productivity; agents expand case coverage .
  • Reimbursement: Granite TPT with $0 device offset; CMS proposals include APC Level 7 outpatient payments and removal of open SIJ fusion from inpatient-only list; strengthens outpatient economics .

Estimates Context

Results vs Wall Street consensus:

MetricQ4 2024Q1 2025Q2 2025
Revenue Consensus Mean ($USD)$48.868M*$45.131M*$48.120M*
Revenue Actual ($USD)$49.002M $47.290M $48.630M
Primary EPS Consensus Mean ($USD)-$0.13429*-$0.2175*-$0.1775*
Diluted EPS Actual ($USD)-$0.11 -$0.15 -$0.14
OutcomeRev/EPS beat*Rev/EPS beat*Rev/EPS beat*

Values retrieved from S&P Global.*

Implication: Consensus models likely need to reflect sustained mid-teens to high-teens top-line growth and improved profitability cadence, including updated FY25 gross margin range and NTAP/TPT reimbursement tailwinds .

Key Takeaways for Investors

  • Raising FY25 guidance and Q2 execution signal durable demand across SIJ fusion, pelvic fixation (Granite), and trauma (TNT), underpinned by favorable reimbursement; expect continued momentum into H2 with typical Q4 seasonality strength .
  • Gross margin resilience (~79.8% in Q2) amidst mix/depreciation headwinds reflects supply chain and manufacturing efficiencies; medium-term GM stabilization expected at 76–77% as new products scale .
  • Physician base and density are powerful leading indicators: 1,440 active U.S. physicians (+25% YoY) and ~$2.1M TTM revenue per territory (+~23%) support sustained growth and operating leverage .
  • Reimbursement catalysts (NTAP for TNT, Granite TPT continuation, outpatient APC changes) provide upside to access and economics, potentially accelerating adoption in H2 and 2026 .
  • Europe TORQ launch creates a 2026 growth lever; near-term impact limited by timing/training — model incremental contribution starting in 2026 .
  • Cash breakeven achieved in Q2 with $1.1M net cash generated; liquidity remains strong at $145.5M, supporting continued R&D and commercial investments ahead of 2026 launches .
  • Trading lens: Near-term catalysts include Q3 seasonality management and Q4 ramp, NTAP effective Oct 1, Granite outpatient economics; medium-term thesis rests on platform breadth, physician density, and margin scalability .
Non-GAAP note: Adjusted EBITDA excludes interest income/expense, depreciation and amortization, and stock-based compensation; reconciliation provided in the press release/8-K **[1459839_cd236b1282f541f8833c704607e8156c_5]** **[1459839_0001459839-25-000073_exhibit991_q225earningsrel.htm:4]**.