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SI

SI-BONE, Inc. (SIBN)·Q3 2025 Earnings Summary

Executive Summary

  • Q3 delivered 20.6% YoY revenue growth to $48.7M, stable 79.8% gross margin, narrowed net loss to $4.6M ($0.11/sh), and positive adjusted EBITDA of $2.3M; management raised FY25 revenue and gross margin guidance, citing broad-based demand and operating discipline .
  • Both revenue and EPS beat S&P Global consensus; revenue beat by ~$2.0M (~4.2%) and EPS by $0.055. Management highlighted positive operating cash flow and second consecutive quarter of net cash flow breakeven as signals of scalability (S&P Global estimates; see Estimates Context) .
  • Demand drivers: accelerating physician adoption (1,530 active U.S. physicians, +27% YoY), interventional case volume doubling, Granite mix shift to multi-implant cases (+~40% using >2 implants), and iFuse TORQ launch in Europe .
  • FY25 guidance raised: revenue to $198–$200M (from $195–$198M) and gross margin to ~79.5% (from 78.5–79.0%); FY26 tailwinds include 17% OBL SI-joint reimbursement increase, TNT NTAP >$4,100 effective Oct 1, 2025, and expected Granite TPT extension .

What Went Well and What Went Wrong

What Went Well

  • Sustained growth and profitability progress: revenue +20.6% YoY to $48.7M; gross margin +75 bps to 79.8%; adjusted EBITDA +$2.3M (~5% margin); first meaningful positive operating cash flow ($2.3M). “Achieving these milestones… underscores the real strength of our differentiated platform, hybrid commercial model, and operating discipline.” – CEO Laura Francis .
  • Expanding adoption and productivity: 1,530 active U.S. physicians (+27% YoY); TTM revenue per territory of $2.1M (+16% YoY); 88 quota-carrying territory managers (up from 85 in Q2) supporting rising demand .
  • Product and reimbursement catalysts: TNT NTAP >$4,100 effective Oct 1 (up to ~30% hospital reimbursement increase for Medicare pelvic fractures); CMS finalized +17% OBL SI-joint reimbursement for 2026; Granite robotics instruments cleared; early EU TORQ launch momentum .

What Went Wrong

  • Sequential growth modest: revenue essentially flat QoQ ($48.7M vs $48.6M) with U.S. at $46.4M in both Q2 and Q3; international remains small though growing ($2.3M) .
  • Operating expenses remain elevated (though leveraged): $44.2M (+11.9% YoY) tied to commercialization and G&A; operating loss remains ($5.4M), albeit improved .
  • S&P-standardized EBITDA remained negative vs consensus expectations despite company’s positive adjusted EBITDA, highlighting metric-definition differences that could confuse comparisons (see Estimates Context; S&P Global values).

Financial Results

P&L trend (oldest → newest)

MetricQ1 2025Q2 2025Q3 2025
Revenue ($M)$47.29 $48.63 $48.66
Gross Margin %79.7% 79.8% 79.8%
Operating Expenses ($M)$45.18 $45.81 $44.23
Operating Loss ($M)$(7.48) $(7.00) $(5.38)
Net Loss ($M)$(6.54) $(6.15) $(4.57)
Diluted EPS ($)$(0.15) $(0.14) $(0.11)
Adjusted EBITDA ($M)$0.47 $1.02 $2.30

Q3 2025 vs Prior Year and Prior Quarter

MetricQ3 2024Q2 2025Q3 2025
Revenue ($M)$40.34 $48.63 $48.66
Gross Margin %79.1% 79.8% 79.8%
Diluted EPS ($)$(0.16) $(0.14) $(0.11)
Adjusted EBITDA ($M)$(0.24) $1.02 $2.30

Q3 2025 vs S&P Global Consensus

MetricConsensusActualBeat/(Miss)
Revenue ($M)$46.67*$48.66 +$1.99M (~+4.2%)*
Primary EPS ($)$(0.165)*$(0.11) +$0.055*
EBITDA ($M)$0.30*$(3.90)*$(4.20) (S&P EBITDA differs from company Adj. EBITDA)

Values retrieved from S&P Global.*

Geographic revenue (oldest → newest)

MetricQ1 2025Q2 2025Q3 2025
U.S. Revenue ($M)$44.8 $46.4 $46.4
International Revenue ($M)$2.5 $2.2 $2.3

KPIs

KPIQ2 2025Q3 2025
Active U.S. Physicians (count)1,440 1,530
TTM Revenue per Territory ($M)$2.1 $2.1
Quota-Carrying Territory Managers (count)85 88

Guidance Changes

MetricPeriodPrevious GuidanceCurrent GuidanceChange
RevenueFY 2025$195M–$198M (~17–18% growth) $198M–$200M (~18–20% growth) Raised
Gross MarginFY 202578.5%–79.0% ~79.5% Raised
Operating ExpensesFY 2025~10% growth at revenue midpoint ~10% growth at revenue midpoint Maintained
Adjusted EBITDAFY 2025Positive Positive Maintained

Earnings Call Themes & Trends

TopicPrevious Mentions (Q1 & Q2 2025)Current Period (Q3 2025)Trend
Physician expansion/densityQ1: “Over 1,400” active U.S. physicians with 300 added in the quarter (+27.3%) 1,530 active (+27% YoY); +330 added; only ~25% of SI joint surgeons perform a second modality; density a key focus Accelerating engagement and cross-modality opportunity .
Interventional/OBL channelNot highlighted in Q1/Q2 releasesInterventional case volume doubled YoY; CMS finalized +17% OBL SI joint reimbursement for 2026 Strong tailwind building into 2026 .
Granite adoption/mixQ2: CMS proposed TPT continuation for CY2026 ~40% growth in >2 Granite implants per case; robotics instruments clearance in Oct; degenerative expansion (Granite 9/5) Mix-driven ASP benefits; outpatient shift supported by TPT/APC .
InternationalQ1: $2.5M; Q2: $2.2M $2.3M; EU TORQ launched; expect acceleration in 2026 Early signs of re-acceleration .
Profitability/cash flowQ1: Adj. EBITDA $0.5M; Q2: $1.0M; Q2 net cash generated $1.1M Adj. EBITDA $2.3M; first meaningful positive operating cash flow $2.3M; TTM Adj. EBITDA $5.7M; aiming for FCF positive in 2026 Improving leverage, cash metrics inflecting .
ReimbursementQ1: Proposed TNT NTAP TNT NTAP >$4,100 effective Oct 1 (up to ~30%); expected Granite TPT extension; proposed APC ~$28k; 17% OBL increase Multi-pronged reimbursement tailwinds into 2026 .
Macro/tariffsQ1: No material impact to GM expected from tariffs PR risk factors continue to cite tariffs and macro as risks Monitored; not a current headwind .

Management Commentary

  • “The robust procedure volume growth across all modalities and record increase in the number of physicians… demonstrate the strength and scalability of our asset-light business model.” – CEO Laura Francis .
  • “We delivered positive adjusted EBITDA of $2.3M… and our first quarter of meaningful positive cash flow from operating activities.” – CEO Laura Francis .
  • “Gross margin was 79.8%, expanding by 75 bps YoY… disciplined pricing and supply chain optimization initiatives.” – CFO Anshul Maheshwari .
  • “We’re updating full-year revenue guidance to $198–$200M… and expect full-year gross margin at 79.5%.” – CFO Anshul Maheshwari .
  • “Interventional case volume doubled… CMS finalized a 17% increase in reimbursement for office-based SI joint procedures for 2026.” – CEO Laura Francis .

Q&A Highlights

  • Physician density lever: only ~25% of SI surgeons perform another modality; expanding cross-platform use and two 2026 launches should deepen density; operating leverage expected in 1.25–1.75x range over time .
  • Guidance philosophy: top-end updated to incorporate ~$2M Q3 outperformance; early Q4 momentum solid (strong October, November trends) despite tougher comp .
  • Gross margin durability: medium-term GM seen stabilizing ~78–78.5% (vs prior expectations), with non-cash depreciation a headwind offset by potential cost reductions and operating leverage .
  • Commercial footprint: target ~100 territories over 12–18 months (from 88); hybrid model expansion (agents) to support demand and 2026 launches .
  • Reimbursement and TNT adoption: NTAP >$4,100 effective Oct 1 supports hospital economics; fielding interest from national trauma distributors to scale TNT .

Estimates Context

  • Q3 2025: Revenue $48.66M vs $46.67M consensus (+$1.99M, ~+4.2%); EPS $(0.11) vs $(0.165) (+$0.055). S&P Global target price consensus: ~$24.89 across 9 estimates (for context).*
  • S&P’s standardized EBITDA actual was $(3.90)M vs $0.30M consensus; note this differs from company-reported adjusted EBITDA of +$2.3M due to metric definitions (S&P excludes add-backs that company includes).*
  • FY25 consensus $199.04M aligns with raised $198–$200M guide; FY26 consensus revenue ~$229.5M mid-teens growth with upside dependent on product ramps and tailwinds.*

Values retrieved from S&P Global.*

Key Takeaways for Investors

  • Quality beat and raise: clear top- and bottom-line outperformance vs consensus, plus higher FY25 revenue and gross margin targets should support positive estimate revisions and sentiment .
  • Structural tailwinds into 2026: 17% OBL reimbursement increase (SI joint), TNT NTAP >$4,100, likely Granite TPT extension, and robotics-enabled workflows underpin multi-year adoption and mix benefits .
  • Execution leverage showing up: 75 bps GM expansion, OpEx down QoQ, adjusted EBITDA inflecting, and positive operating cash flow—supporting the case for FCF positive in 2026 .
  • Physician flywheel: record quarterly physician adds (+330) and low cross-modality penetration (~25%) create a long runway for density-driven growth as the platform expands .
  • International optionality: early EU TORQ momentum should contribute more visibly in 2026; broader OUS portfolio expansion under evaluation .
  • Watch the definitions: S&P-standardized EBITDA will differ from company adjusted EBITDA; anchor EPS and revenue comparisons on S&P for consistency, but use company Adj. EBITDA to track internal profitability .
  • Near-term catalysts: Q4 print vs elevated comp; updates on 2026 SI-joint and late-2026 breakthrough device timelines; distributor partnerships for TNT; progress toward ~100 territories .