Executive Summary

Q4 2024 revenue was $22.5M (+11% YoY), driven by $4.4M of Greenbrook clinic revenue post-close; however core U.S. system (-15% YoY) and treatment session (-14% YoY) revenues declined, and gross margin compressed 1,140 bps to 66.2% on clinic mix .
Operating expenses increased with acquisition and one-time items; the company later revised Q4 to net loss $(12.7)M and adjusted EBITDA $(0.4)M (from prior +$0.1M), reflecting purchase accounting updates tied to the Greenbrook deal .
2025 guidance maintained: Q1 revenue $28–30M; FY revenue $145–155M; gross margin ~55%; OpEx $90–98M; management continues to target cash-flow positive beginning in Q3 2025, underpinning the post-merger investment case .
Integration is on track: actions to realize >$21M of the targeted $22M annualized cost synergies are executed; growth catalysts include BMP expansion, utilization lift in clinics, and aggressive SPRAVATO buy-and-bill rollout (35 clinics now; targeting most locations by YE25) .
Stock narrative catalysts: successful synergy capture and execution on SPRAVATO/buy-and-bill and BMP expansion supporting the FY25 guide and the Q3’25 cash-flow-positive milestone .

What Went Well and What Went Wrong

What Went Well
- Closed transformative Greenbrook acquisition (Dec 9) creating a vertically integrated model; executed actions to realize >$21M of $22M targeted annualized cost synergies; added $4.4M Q4 clinic revenue .
- Management reiterated a path to mid-teens FY25 pro forma growth and cash-flow positive in Q3’25; reiterated Q1 and FY25 guidance on the call and in the press release .
- CEO message: “Neuronetics now stands as the clear leader in TMS therapy … building momentum toward … becoming cash flow positive in Q3 2025” .
What Went Wrong
- Gross margin fell to 66.2% (vs 77.6% LY) due to clinic mix and lower treatment session revenue; U.S. system and treatment revenues declined YoY (-15% and -14%), partly due to eliminating intercompany treatment revenue post-acquisition .
- Q4 operating expenses rose to $26.4M (revised), reflecting Greenbrook-related professional fees and consolidation; net loss widened to $(12.7)M (revised) .
- Q4 adjusted EBITDA revised to $(0.4)M from initial +$0.1M after final purchase accounting updates, tempering the initial non-GAAP profitability narrative .

Financial Results

Summary by quarter (oldest → newest)

Metric	Q3 2024	Q4 2024
Revenue ($M)	$18.53	$22.49
Gross Margin %	75.6%	66.2%
Operating Expenses ($M)	$21.73	$26.37 (revised)
Net Loss ($M)	$(13.34)	$(12.68) (revised)
Diluted EPS ($)	$(0.44)	$(0.34) (revised)
Systems Shipped (units)	49	46 (PR); company slide shows 47 (see note)
U.S. Treatment Session Revenue ($M)	$13.33	$12.86
U.S. Clinic Revenue ($M)	$0.00	$4.45
Cash & Cash Equivalents ($M, period-end)	$20.87	$18.46

Note on shipments: press release states 46 systems shipped in Q4; supplemental slide table shows 47; we anchor to the press release and flag the discrepancy .

YoY performance (Q4 2024 vs Q4 2023)

Metric	Q4 2023	Q4 2024	YoY
Revenue ($M)	$20.31	$22.49	+11%
Gross Margin %	77.6%	66.2%	-1,140 bps
Operating Expenses ($M)	$20.20	$26.37 (revised)	+31% (revised)
Diluted EPS ($)	$(0.19)	$(0.34) (revised)	N/M

Segment/Category details

Category (U.S. unless noted)	Q4 2023 ($M)	Q4 2024 ($M)	YoY
NeuroStar Advanced Therapy System	$4.52	$3.85	-15%
Treatment Sessions	$14.88	$12.86	-14% (intercompany elimination post-close)
Clinic Revenue (Greenbrook)	$0.00	$4.45	N/A
Other	$0.47	$0.49	+4%
U.S. Total	$19.87	$21.64	+9%
International	$0.44	$0.85	+93%
Total Revenue	$20.31	$22.49	+11%

Revenue trend (sequential)

Metric	Q2 2024	Q3 2024	Q4 2024
Total Revenue ($M)	$16.45	$18.53	$22.49
U.S. Systems Revenue ($M)	$4.00	$4.11	$3.85
U.S. Treatment Session Revenue ($M)	$11.66	$13.33	$12.86
U.S. Clinic Revenue ($M)	$0.00	$0.00	$4.45
Systems Shipped (units)	50	49	46 (PR); slide shows 47

Non-GAAP

Adjusted EBITDA Q4 2024 revised to $(0.415)M (from initial +$0.108M), reflecting acquisition accounting updates; FY 2024 adjusted EBITDA revised to $(21.79)M .

Guidance Changes

Metric	Period	Previous Guidance	Current Guidance	Change
Revenue	Q1 2025	No prior Q1 guide disclosed publicly	$28.0–$30.0M	New item disclosed
Revenue	FY 2025	$145–$155M (Jan 13, 2025)	$145–$155M (Mar 4, 2025)	Maintained
Gross Margin	FY 2025	~55% (Jan 13, 2025)	~55% (Mar 4, 2025)	Maintained
Total OpEx	FY 2025	$90–$98M (Jan 13, 2025)	$90–$98M (Mar 4, 2025)	Maintained
Profitability	FY 2025	Cash flow positive beginning Q3 2025 (Jan 13, 2025)	Cash flow positive beginning Q3 2025 (Mar 4, 2025)	Maintained

Context (prior quarter): On Nov 12, 2024, Neuronetics guided standalone Q4 2024 revenue to $19–$20M and FY 2024 to $71–$72M; the consolidated Q4 actual was $22.5M (includes Greenbrook post-close) and FY 2024 was $74.9M .

Earnings Call Themes & Trends

Topic	Previous Mentions (Q-2 and Q-1)	Current Period (Q4 2024)	Trend
Greenbrook integration and cost synergies	Q3: Shareholders approved acquisition; synergies expected; cash-flow breakeven by Q3’25 .	Closed Dec 9; >$21M of $22M targeted synergies executed; reaffirmed Q3’25 cash-flow positive .	Improving execution; synergy realization ahead of plan.
BMP (Better Me Provider) rollout and impact	Q3: National rollout underway; >350 sites .	BMP participants treat ~3x more patients; 350 sites now, 125+ working to join; reducing time to treatment 2.2x faster .	Scaling; positive throughput and responsiveness metrics.
SPRAVATO buy-and-bill	Q3: Planned acceleration post-merger .	63 clinics offering; 35 on buy-and-bill; goal: most clinics by YE25; 75% of GBK growth tied to SPRAVATO in FY25 plan .	Rapid rollout; meaningful growth lever.
Margins and consolidation mix	Q3 GM 75.6% (pre-clinic mix) .	FY25 GM guided ~55% due to clinic mix; GBK clinic margins to mid-30s after underperforming closures .	Structural GM reset; pathway to improve clinic margins.
Seasonality and cadence	Historic seasonality highlighted (Q1 ~19–20% of annual) .	Q1’25 guide $28–30M; expect ramp through Q2/Q3 and strongest Q4 .	Normal pattern expected post-integration.
Change Healthcare impact	Headwinds in 2024 .	Disruption largely behind; alternative processing implemented .	Operational recovery supports 2025 execution.

Management Commentary

CEO: “By expanding our Better Me Provider network and acquiring Greenbrook, we’ve created an unparalleled TMS treatment platform while rapidly improving our financial position.”
CEO: “We’re building momentum toward our dual objectives of double-digit revenue growth for the year and becoming cash flow positive in Q3 2025.”
CFO: “Gross margin was 66.2%… primarily a result of the inclusion of the Greenbrook clinics business… Q4 EBITDA includes approximately $10.6M in nonrecurring expenses.”
CEO: “We are nearly 40% through the SPRAVATO buy-and-bill rollout… now over 35 clinics utilizing this billing method… will offer buy-and-bill in most Greenbrook clinics by the end of 2025.”
CFO (clinics): “GBK clinic margins… 27–28% in 2024; implied guidance for 2025 is mid-30%s, driven by closure of 35 underperforming clinics.”

Q&A Highlights

Guidance composition: FY25 revenue split framework ~$65–$70M Neuronetics standalone and ~$80–$85M Greenbrook, predicated on BMP-driven growth and SPRAVATO expansion/buy-and-bill conversion .
Margin levers: Consolidated GM guided to ~55% with GBK clinic margins improving to mid-30%s; continued cost-out in NeuroStar manufacturing and clinic optimization .
SPRAVATO cash dynamics: Minimal CapEx per clinic (~$10k); working-capital need for drug inventory potentially up to ~$5M, mitigated via distributor 120-day terms and recent $18.9M equity raise .
Utilization targets: GBK average ~4 patients/day per system; BMP sites at 6–8; plan to lift GBK to 5–6 over 2025–2026; +1 patient/day ≈ ~$10M annualized revenue opportunity .
Footprint strategy: Hold GBK at 95 clinics (most profitable set) and focus on utilization and process standardization rather than expansion .

Estimates Context

We attempted to retrieve S&P Global consensus for Q4 2024 revenue and EPS; the request could not be fulfilled due to a daily request limit. As a result, we cannot provide definitive beat/miss vs Wall Street consensus at this time (S&P Global data unavailable).
Given management’s commentary and the reported results, potential estimate revisions for FY25 may center on: (i) pace of SPRAVATO buy-and-bill conversion, (ii) clinic utilization ramp, and (iii) synergy realization cadence .

Key Takeaways for Investors

Integration is executing: >$21M of ~$22M cost synergies already actioned; lowers OpEx base and supports FY25 cash-flow inflection goal (Q3’25) .
Structural mix shift: Consolidation with clinics resets gross margins (~55% guide) but provides scale and recurring service revenue; clinic margin improvement (mid-30%s) is central to earnings power .
Growth engines: BMP expansion (350+ sites, +125 in pipeline) and SPRAVATO buy-and-bill (35 clinics now; most by YE25) are the primary revenue drivers embedded in FY25 guidance .
Q4 quality signals mixed: headline growth +11% YoY aided by clinic revenue, but core system and treatment revenues declined YoY and gross margin compressed; one-time acquisition costs weighed on non-GAAP performance (revised) .
FY25 setup: Guidance maintained from Jan to Mar; early-2025 execution on utilization and SPRAVATO conversion will be key check-ins versus targets .
Liquidity/working capital: $18.5M cash at YE24 plus $18.9M equity raise post-quarter strengthen flexibility to fund SPRAVATO inventory and integration initiatives .
Watchlist for next quarter: cadence of SPRAVATO clinic adds and buy-and-bill conversions; BMP site adds; GBK utilization lift; confirmation of margin improvement and synergy capture pace .

Appendix: Additional Context

Transaction closing PR (Dec 10, 2024) confirms combined structure and integration priorities .
Q3 2024 PR correction (Nov 12, 2024) reiterates cash-flow breakeven targeted for Q3’25; Q3 revenue $18.5M; GM 75.6% .
March 27, 2025 update revised Q4 and FY 2024 GAAP/adjusted metrics due to Greenbrook purchase accounting and share count; we use revised figures throughout .

Neuronetics, Inc. (STIM)·Q4 2024 Earnings Summary