Executive Summary

Q4 2024 delivered record revenue of $49.0M (+~26% YoY) and positive adjusted EBITDA ($1.9M), with U.S. revenue up ~28% to $46.9M and gross margin ~79% .
2025 guidance: revenue $193.5–$195.5M (+~16–17% YoY), gross margin 77–78%, OpEx growth ~9% at the midpoint, and positive adjusted EBITDA for 2H and full-year 2025; assumptions include low-to-mid single-digit ASP decline, one fewer procedure day, and some FX headwind .
Strategic momentum: Granite 9.5 adoption outpacing prior launches, TNT early demand exceeding expectations, and third FDA Breakthrough Device Designation underscore platform expansion; Transitional Pass-Through (TPT) status for Granite effective Jan 1, 2025 is a reimbursement tailwind .
Consensus (S&P Global) estimates for Q4 2024 were unavailable at the time of analysis due to API rate limits, so we cannot quantify beat/miss; we will update when accessible.

What Went Well and What Went Wrong

What Went Well
- Record quarter with diversified growth: “We hit records across all of our KPIs… Granite 9.5… exceeded our expectations… TNT… exceeded our expectations,” and delivered positive adjusted EBITDA .
- Commercial leverage and productivity: ended 2024 with 87 U.S. territory managers; territory productivity nearly doubled over three years to $1.8M in 2024; hybrid model and agent partnerships scaling efficiently .
- Reimbursement tailwinds: CMS granted TPT with $0 device offset for Granite starting Jan 1, 2025, enabling full pass-through of device cost in outpatient setting, a clear adoption catalyst .
What Went Wrong
- Mix and ASP pressure ahead: 2025 outlook embeds low-to-mid single-digit ASP decline from procedure mix evolution (certain procedures use fewer implants) .
- Seasonality and cadence: management expects typical high-single-digit sequential decline from Q4 to Q1 and adjusted EBITDA negative in 1H 2025 before 2H improvement .
- Ongoing DOJ investigation: no material update; focus areas include field-based education events/meals/speaker programs and physician remuneration; timing of resolution unclear .

Financial Results

Metric	Q4 2023	Q2 2024	Q3 2024	Q4 2024
Revenue ($M)	$38.86	$39.97	$40.34	$49.00
YoY Revenue Growth (%)	~	~20%	~19%	~26%
Gross Margin (%)	~74% (impacted by reserve)	~79%	~79%	~79%
Gross Profit ($M)	$28.68	$31.58	$31.90	$38.78
Operating Expenses ($M)	$41.18	$41.65	$39.54	$44.27
Operating Income (Loss) ($M)	$(12.51)	$(10.08)	$(7.63)	$(5.49)
Net Income (Loss) ($M)	$(10.98)	$(8.94)	$(6.58)	$(4.50)
EPS (GAAP, $)	$(0.27)	$(0.22)	$(0.16)	$(0.11)
Adjusted EBITDA ($M)	$(4.81)	$(2.68)	$(0.24)	$1.86
Cash & Marketable Securities ($M)	$166.0 (12/31/23)	$151.5 (6/30/24)	$150.8 (9/30/24)	$150.0 (12/31/24)
Borrowings ($M)	$36.1 (12/31/23)	$36.1 (6/30/24)	$36.2 (9/30/24)	$35.5 (12/31/24)

Segment revenue breakdown (U.S. vs International):

Metric	Q4 2023	Q2 2024	Q3 2024	Q4 2024
U.S. Revenue ($M)	$36.7	$37.8	$38.3	$46.9
International Revenue ($M)	$2.2	$2.2	$2.1	$2.1

KPIs and commercial indicators:

KPI	Q4 2023	Q2 2024	Q3 2024	Q4 2024
Active U.S. Physicians (approx)	—	>1,150	>1,200	~1,400
Quota-carrying U.S. Territory Managers	—	84	82	87
TTM Revenue per Territory ($M)	—	$1.7	$1.8	$1.8 (2024)
Multi-Procedure Physicians (YoY increase)	—	+25%	+35%	+~40%

Notes:

Non-GAAP adjusted EBITDA excludes interest income/expense, D&A, and stock-based comp; see reconciliation and non-GAAP definition .

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Worldwide Revenue ($M)	FY 2025	N/A (no prior 2025 guide)	$193.5–$195.5	Introduced
Gross Margin (%)	FY 2025	N/A	77–78	Introduced
Operating Expenses Growth	FY 2025	N/A	~9% at midpoint	Introduced
Adjusted EBITDA	FY 2025	N/A	Positive 2H and FY	Introduced

Additional color: Guidance assumes low-to-mid single-digit ASP decline from mix, one less procedure day in 2025, and FX headwind; upside levers include broader Granite 9.5/TNT commercialization and reimbursement tailwinds (TPT/NTAP potential) .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q-2 and Q-1)	Current Period (Q4 2024)	Trend
Technology/product roadmap (Granite 9.5, TNT, BDD)	Granite 9.5 launch driving ASP/density; TNT launched with BDD; strong adoption; plan for trauma product in Q4; pipeline building	Granite 9.5 “resounding success”; TNT early demand exceeded expectations; third BDD awarded; disruptive device under development	Accelerating adoption and portfolio breadth
Reimbursement (TPT/NTAP)	Granite TPT effective 1/1/2025; NTAP path for TNT targeted for Oct 2025	CMS finalized TPT with $0 device offset, enabling full pass-through; pursuing NTAP for TNT	Reimbursement tailwinds strengthening
Supply chain/operations	Streamlining supply chain lowered costs and aided margins; set build for Granite	Gross margin benefited from supply chain actions; onboarding surgical capacity may raise depreciation	Operational efficiency continuing; some near-term mix/depreciation headwinds
Macro/seasonality	Q3 impacted by hurricanes/IV shortages; 3Q→4Q capacity constraints; thoughtful outlook	Expect high-single-digit sequential decline Q4→Q1; one fewer procedure day; FX headwind	Seasonality and conservative assumptions persist
Product performance & density	Granite 9.5 improving stacked usage; interventional led by TORQ; increasing cross-modality use	Multi-procedure physicians up ~40%; strong TORQ/INTRA positioning; density a key 2025 priority	Density building; cross-modality rising
Regional trends	U.S. drives growth; international rebounded modestly	U.S. +~28% YoY in Q4; international ~$2.1M	U.S.-led growth sustained
Regulatory/legal	—	DOJ investigation ongoing; cooperating; focus on education/remuneration practices	Unresolved; monitoring

Management Commentary

“We delivered positive adjusted EBITDA in the fourth quarter… we expect to deliver positive adjusted EBITDA for the full year 2025 and expect adjusted EBITDA margins to expand going forward.” – CEO Laura Francis .
“Granite 9.5 has been a resounding success… TNT… has exceeded our expectations… early demand indicators give us confidence [they] can be major growth drivers in 2025 and beyond.” – CEO Laura Francis .
“We have robust momentum entering 2025… guidance assumes strong volume growth… offset by low-to mid-single-digit ASP impact from evolution of the procedure mix.” – CFO Anshul Maheshwari .
“CMS granted a $0 device offset [for TPT], which… allows hospitals to pass through 100% of the Granite cost… in addition to their usual facility fee.” – CEO Laura Francis .

Q&A Highlights

2025 growth guide vs recent mid-20s trend: management took a “balanced” approach given mix-driven ASP pressure, one fewer procedure day, FX, and the ramp timing of reimbursement/product capacity; upside remains from density and TPT/NTAP .
Margin outlook: gross margin midpoint (77.5%) reflects mix, added depreciation from capacity/software; medium-term gross margin profile seen at ~76–77% with cost actions to offset pressures .
Cadence: typical high-single-digit sequential decline Q4→Q1; adjusted EBITDA negative 1H, turning positive in 2H (more Q4-weighted) .
Sales productivity: hybrid model and agent partnerships roughly doubled territory productivity to ~$1.8M; selective rep adds expected; aim >$2M per territory over time .
DOJ: cooperating; no material updates; focus on field education events and remuneration practices .

Estimates Context

S&P Global consensus estimates for Q4 2024 (revenue, EPS, target price, and estimate counts) were unavailable at the time of analysis due to API rate limits, so we cannot quantify beat/miss or dispersion versus consensus at this time. We will refresh and update the comparisons once access is restored.
Management did not reference explicit consensus comparisons in the press release or call; primary focus was on record revenue, positive adjusted EBITDA, and 2025 guidance framework .

Key Takeaways for Investors

Platform momentum with multiple growth vectors (SI joint with TORQ/INTRA, deformity/degenerative with Granite 9.5, trauma with TNT) underpins high-teens 2025 growth and a path to sustained EBITDA profitability; reimbursement tailwinds (TPT now, NTAP potential) are additive .
Mix and seasonality introduce near-term optics: expect Q1 sequential step-down and ASP headwinds from mix, but density gains and capacity additions should support 2H acceleration and 2025 EBITDA positivity .
Granite 9.5 adoption and stacked usage trends are key catalysts for ASP/density; TPT with $0 offset can expand outpatient use, lowering site-of-service friction for hospitals .
TNT’s early traction and NTAP pursuit (targeting Oct 2025) create a new leg of growth in pelvic fractures with a sizable TAM; watch for capacity expansion and agency partnerships .
DOJ investigation remains a risk overhang; no material updates but continued cooperation—monitor for any resolution or changes in commercial practices .
Execution focus: physician base (~1,400 active in Q4), cross-modality density (+~40%), and hybrid sales model support durable operating leverage and progressing toward free cash flow over time .
Revisit consensus once available to reassess beat/miss and potential estimate revisions following guidance and Q4 outperformance messaging.

Supporting Press Releases (Q4 2024 timeframe)

CMS grants TPT for Granite effective Jan 1, 2025 with $0 device offset, enabling full pass-through of device cost in outpatient setting .
First-in-patient procedures with iFuse TORQ TNT breakthrough device; strong initial surgeon feedback and 510(k) clearance in Aug 2024 .

SI-BONE, Inc. (SIBN)·Q4 2024 Earnings Summary