Neuronetics (STIM) Q4 2025 Earnings Transcript

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Date

Tuesday, March 17, 2026 at 8:30 a.m. ET

Call participants

• President and Chief Executive Officer — Keith J. Sullivan
• Incoming President and Chief Executive Officer — Dan Reavers
• Chief Financial Officer — Steven E. Pfanstiel
• Chief Technology Officer — Corey Anderson

Takeaways

• Leadership transition -- Dan Reavers will become President and Chief Executive Officer effective March 23, with Keith J. Sullivan remaining for transition support.
• Total revenue -- $41.8 million, up 86% due to the inclusion of Greenbrook operations; pro forma growth was 23%.
• NeuroStar business revenue -- $18.3 million (system and treatment session), with pro forma growth of 9%.
• U.S. NeuroStar system revenue -- $4.4 million, up 15% on a pro forma basis, with 49 systems shipped (compared to 46 units in the prior year).
• U.S. treatment session revenue -- $12.4 million, a pro forma increase of 6%.
• Clinic revenue -- $23.5 million, 37% growth pro forma, with increases in both NeuroStar TMS and SPRAVATO treatments.
• Gross margin -- 52%, down from 66%, mainly due to lower-margin Greenbrook clinic business; fourth quarter margin was the year's highest, reflecting improved operational efficiency and product mix.
• Operating expenses -- $26.7 million, increasing $0.4 million or 1.4%, driven by $8.5 million in Greenbrook general and administrative expenses, partially offset by reduced R&D costs.
• Stock-based compensation -- $2.2 million in non-cash expense recorded in the quarter.
• Net loss -- $7.2 million, or $0.10 per share, improved from $12.7 million, or $0.34 per share.
• EBITDA -- Negative $4.3 million, an improvement from negative $11.0 million.
• Cash position -- $34.1 million as of Dec. 31, 2025 ($28.1 million cash and equivalents, $6.0 million restricted); after a $5.0 million debt repayment to Perceptive, pro forma cash is $29.1 million.
• Operating cash flow -- Positive $0.9 million in the fourth quarter, after improving sequentially from negative $17.0 million in the first quarter.
• Greenbrook clinic performance -- Adjusted pro forma clinic revenue grew 28% for the year; 430 new referring providers added in the fourth quarter (25% increase), with 1,300 new referrers annually; 47,000+ outreach activities completed, driving over 2,300 patient referrals (up 46%).
• Total treatment volume -- Up 18% year over year in the fourth quarter, reflecting combined TMS and SPRAVATO patient growth.
• SPRAVATO rollout -- Nearly complete, with 84 clinics active and billing practices optimized for clinic, payer, and state characteristics.
• Workflow optimization -- Introduction of tablet kiosks and piloting of an all-digital patient portal to streamline check-in and intake.
• AI benefits investigation -- AI tools deployed to expedite claims filing, enhance first-pass acceptance rates, and lower labor requirements.
• Better Me Provider (BMP) program -- Over 420 active sites at year-end, with nearly 100 working toward qualification; BMP sites show higher patient volumes, faster response, and increased session utilization.
• Insurance coverage expansion -- TRICARE West expanded TMS coverage to adolescents (age 15+) across 26 states, broadening addressable patient population.
• Provider Connection program -- Launched April; 400+ educational meetings, over 210 new referral sites established.
• Partner services -- Greenbrook's intake center now supports partners with benefits investigation and patient management, delivering financial clarity in 24 hours and guiding patients through to treatment.
• Debt modification -- Perceptive agreement amended in March 2026, reducing debt and interest expense by approximately $600,000 annually through a $5.0 million principal payment.
• 2026 revenue guidance -- Expected total revenue $160 million to $166 million, implying more than 9% growth; clinic revenue forecasted to grow double digits to mid-teens, NeuroStar business to grow low to mid-single digits.
• First quarter 2026 revenue guidance -- Projected $33 million to $35 million, reflecting seasonality and prior period dynamics.
• 2026 gross margin guidance -- Anticipated range 47%-49%, shaped by efficiency gains and favorable product mix.
• 2026 operating expenses guidance -- Targeted $100 million to $105 million (includes approximately $8.5 million non-cash stock-based compensation), with fourth quarter run-rate expected under $100 million.
• 2026 operating cash flow guidance -- Anticipated negative $13 million to negative $17 million for the year; first quarter to be most cash-intensive with improvement expected starting in the second quarter and positive operating cash flow anticipated during the second half.
• Growth initiatives -- New NeuroStar TMS go-to-market models piloted in the first quarter; capital sales team expanded to pursue broader customer segments.
• Pipeline development -- Collaboration with COMPASS Pathways on COMP360 psilocybin treatment for TRD advancing; Phase 3 results positive, NDA submission targeted for year-end, commercial rollout preparation underway through Greenbrook clinics.

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Risks

• Chief Financial Officer Steven E. Pfanstiel disclosed an ongoing investigation by the U.S. Attorney's Office in the Middle District of Florida concerning billing practices prior to the Greenbrook acquisition, with full cooperation from Neuronetics.
• Gross margin declined to 52% from 66%, explicitly stated as driven by the addition of Greenbrook's lower-margin clinic business.
• 2026 operating cash flow guidance projects a negative range between $13 million and $17 million, with management cautioning that the first quarter is typically the most cash-intensive quarter due to seasonality and annual outlays.

Summary

Neuronetics (NASDAQ:STIM) reported 23% pro forma revenue growth and reached positive operating cash flow in the fourth quarter, following successful integration of Greenbrook operations and expansion of both TMS and SPRAVATO clinics. Management announced a CEO transition effective March 23 and highlighted commercialization readiness for COMP360 psilocybin therapy, citing compelling Phase 3 results and a pending NDA. Notably, system shipments increased and new provider/referrer initiatives generated record patient referrals and improved payer coverage for adolescent depression. Technical upgrades in clinic workflow and claims processes, including AI-based tools, contributed to efficiency gains and stronger fourth quarter gross margin. Neuronetics amended its debt agreement, reducing principal and projecting $600,000 in annual interest savings, while providing detailed operational and financial guidance that anticipates sequential improvement in cash flow during the second half of the year.

• The intake center is delivering new partner services built on Greenbrook's infrastructure, broadening service reach beyond internal clinics.
• BMP program expansion and the Provider Connection initiative are supporting accelerated new patient onboarding across the network.
• Clinic revenue is expected to constitute the majority of forward revenue growth, with sustained focus on operational discipline and expense containment.
• COMPASS collaboration positions Neuronetics as a preferred, not exclusive, partner for new TRD therapies, leveraging existing REMS infrastructure with limited additional capital required for rollout.

Industry glossary

• Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation technique used for treating depression by applying magnetic fields to induce electrical currents in targeted brain regions.
• REMS (Risk Evaluation and Mitigation Strategies): FDA-mandated protocols that ensure the safe use of certain therapies, often requiring clinic-based administration and monitoring.
• SPRAVATO: Brand name for esketamine, a nasal spray treatment for depression, requiring REMS compliance and clinic supervision.
• Buy-and-bill (BNB): A medication reimbursement model where clinics purchase drugs directly, administer them, and then bill insurers, affecting cash collection and billing complexity.
• COMP360: Investigational psilocybin therapy developed by COMPASS Pathways for treatment-resistant depression, under review for FDA approval.
• Treatment-resistant depression (TRD): Major depressive disorder that does not respond to at least two different antidepressant treatments.
• Better Me Provider (BMP): Neuronetics' network program connecting TMS-interested patients with qualified NeuroStar treatment sites focused on high patient throughput and engagement.

Full Conference Call Transcript

Keith J. Sullivan, and Steven E. Pfanstiel, Neuronetics, Inc.'s Chief Financial Officer. Before we begin, I would like to caution listeners that certain information discussed by management during this conference call will include forward-looking statements covered under the Safe Harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements related to our business, strategy, financial and revenue guidance, the Greenbrook integration, and other operational issues and metrics. Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.

For a discussion of risks and uncertainties associated with Neuronetics, Inc.'s business, I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's Annual Report on Form 10-K, which was filed premarket today. The company disclaims any obligation to update any forward-looking statements made during the course of this call, except as required by law. During the call, we will also discuss certain information on a non-GAAP basis, including EBITDA. Management believes that non-GAAP financial information, taken in conjunction with U.S. GAAP financial measures, provides useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of trends in our operating results.

Management uses non-GAAP financial measures to compare our performance relative to forecast and strategic plans, to benchmark our performance externally against competitors, and for certain compensation decisions. Reconciliations between U.S. GAAP and non-GAAP results are presented in the tables accompanying our press release, which can be viewed on our website. With that, it is my pleasure to turn the call over to Neuronetics, Inc.'s President and Chief Executive Officer, Keith J. Sullivan.

Keith J. Sullivan: Thanks, Mark. Good morning, everyone, and thank you for joining us today. Before I get into our results, I am pleased to announce that the Board has appointed Dan Reavers as our next President and Chief Executive Officer of Neuronetics, Inc., effective March 23. Dan is a proven leader with more than 30 years in medical devices, and he knows how to build and scale commercial health care businesses. Having spent time with Dan through the search process, I am confident he is the right person to lead the company into the next chapter, and I am looking forward to working with him to ensure a smooth transition. Now turning to our performance.

A little over a year ago, we closed the Greenbrook acquisition and set out to build a vertically integrated mental health company with the technology, the clinical infrastructure, and the scale to fundamentally change how patients access treatment for mental health conditions. I am proud to say that in our first full year as a combined company, we have done exactly that. We delivered strong fourth quarter results with adjusted pro forma revenue growth of 23%, driven by our strongest capital shipment quarter of the year and continued momentum across our Greenbrook clinic network.

We also achieved the key milestone of positive operating cash flow in the fourth quarter, driven by revenue growth, operational discipline, and the cash collection improvements that we have been implementing throughout the year. Starting with the update on Greenbrook. Over the course of 2025, we executed against our growth initiatives, and the results speak for themselves. Full-year clinic revenue grew 28% on an adjusted pro forma basis. Our Regional Account Manager program is building awareness among referring providers and helping more patients find relief from their depression in our clinics. In the fourth quarter, our referring provider network added 430 new providers, a 25% increase year over year, contributing to over 1,300 new referrers added across 2025.

This growth was supported by significantly higher field engagement, with our regional teams completing more than 47,000 physician outreach activities during the year. These efforts drove over 2,300 patient referrals in Q4, representing a 46% increase over the prior-year period. Our automated patient transfer process, educational tools, scheduling QR codes, and coordinated intake team engage patients while they are still at the primary care doctor's office. These capabilities are improving referral-to-treatment conversion while reducing friction for both the provider and the patient across the Greenbrook network. We are nearly complete with our SPRAVATO rollout, with 84 clinics now providing the treatment.

Throughout 2025, we optimized our billing practices based on the economics of buy-and-bill versus administer-and-observe, and we have taken a disciplined approach to deploying the right billing model by state, by payer, and by clinic. Our efforts across both SPRAVATO and TMS continue to drive strong results, with total treatment volume up 18% year over year in the fourth quarter. On the operational side, we continue to drive standardization across the network, focused on getting patients into treatment faster and simplifying their experience at our clinics. We deployed tablet kiosks across all locations, streamlining check-in and making it simple for a patient to remit their patient-responsibility payments at the time of the visit.

We are also piloting a patient portal that allows patients to complete intake forms and submit insurance information before their appointment, with the goal of offering an all-digital intake pathway in the future. We are starting to leverage AI in our benefits investigation, with initial applications helping us file claims faster and more accurately, increasing first-pass acceptance rates while reducing labor. Collectively, these efforts are enabling our team to care for more patients daily while improving our cash conversion. Turning to our NeuroStar business and the BMP program. On the system side, we had a strong finish to the year, shipping 49 systems in the quarter at an average selling price above our target for the fourth consecutive quarter.

That tells us customers continue to see the value in NeuroStar and in the support that comes with it. As we have discussed throughout the year, we made a deliberate decision to realign our capital team towards higher-volume, higher-growth accounts that could add NeuroStar TMS into their practices quickly, meaning that they have the staff available to incorporate TMS into their practice, are credentialed with insurance payers, and therefore can get up and running treating patients faster. With that focus on TMS-ready accounts, we are seeing the benefits in system ASP, a reduction in resources needed to go from purchase to treatment of the first patient, and in the quality of accounts we are adding to the network.

We believe this positions our NeuroStar business well heading into 2026, and I will discuss more about that shortly. On a pro forma basis, treatment session revenue increased 6% in Q4 on strong treatment utilization growth of 11%. Our Better Me Provider program had over 420 active sites at the end of 2025, with nearly 100 additional sites working towards qualification. Since inception, the program has connected more than 66,000 patients interested in NeuroStar TMS with one of our Better Me Providers. BMP sites continue to deliver significantly higher patient volumes and faster response times than nonparticipating sites, and we have observed that treatment session utilization is increasing at these sites, indicating strong patient flow and demand for existing equipment.

We also continue to see growing recognition of NeuroStar TMS as a treatment option for adolescents. During the quarter, TRICARE West expanded coverage for TMS therapy to include adolescents age 15 and older diagnosed with depression, and the coverage is effective across 26 states. That is a meaningful development for military families and further validates the expanding insurance landscape for adolescent TMS treatment. Moving on to our Provider Connection program, which we launched last April. The program has gained real traction. Our field team has held over 400 educational meetings resulting in more than 210 new referral sites by year end. We have also seen strong engagement through the directed provider campaigns and the inside sales outreach efforts.

This program takes what we have learned at Greenbrook about educating primary care physicians on the benefits of NeuroStar TMS and applies it across our entire NeuroStar customer base, and it is becoming a meaningful part of how we help patients find and access care with NeuroStar providers. We are also leveraging our Greenbrook infrastructure to offer new services to our NeuroStar customers. Through our intake center, we are now providing benefits investigations and patient management support to partners like Transformations Care Network and Elite DNA.

Our benefits investigation model delivers financial clarity to patients within 24 hours, helping practices accelerate patient decision-making, and our patient management program guides patients from initial interest through to treatment, ensuring seamless engagement at every step. These programs are already driving new patient starts at our partner sites and represent a scalable model that we can extend across our national enterprise accounts. Stepping back, I want to put this year into context. When we announced the Greenbrook acquisition, we laid out a thesis that combining NeuroStar's technology platform and training programs with the Greenbrook National Care Delivery Network, we would expand patient access, accelerate growth, and create a path to profitability. One year in, that thesis is playing out.

We grew revenue, we reached positive operating cash flow, we strengthened our balance sheet, and we built a platform that is now enabling opportunities that neither company could have pursued on its own. I will now turn it over to Steve to take you through the financial details, and then I will come back to talk about what those opportunities look like heading into 2026.

Steven E. Pfanstiel: Thank you, Keith. Good morning, everyone. Unless otherwise noted, all performance comparisons are being made for 2025 versus 2024. Total revenue in the fourth quarter was $41.8 million, an increase of 86% compared to revenue of $22.5 million in 2024, primarily driven by the inclusion of Greenbrook operations following our acquisition in December 2024. On an adjusted pro forma basis, fourth quarter revenue increased 23% versus the prior year. Total revenue from our NeuroStar business, inclusive of our system revenue as well as treatment session revenue, was $18.3 million in 2025. On a pro forma basis, taking into account the impact of the intercompany revenue, this represents an increase of 9% versus the prior year. U.S.

NeuroStar system revenue was $4.4 million, an increase of 15% on a year-over-year pro forma basis, and we shipped 49 systems in the quarter. This compares favorably to our fourth quarter 2024 shipments of 46 units, and we continue to see strong system ASP in the quarter. U.S. treatment session revenue was $12.4 million. On a pro forma basis, treatment session revenue increased 6% compared to the prior-year quarter. The reported decline of 4% is primarily attributable to the absence of prior-year Greenbrook intercompany purchases. Clinic revenue was $23.5 million for the three months ended 12/31/2025, a 37% increase on an adjusted pro forma basis, driven by growth in treatments across both NeuroStar TMS and SPRAVATO treatments.

Gross margin was 52% in 2025 compared to 66% in the prior-year quarter. The decrease was due to the inclusion of Greenbrook's clinic business, which operates at a lower margin. It is worth noting that Q4 gross margin was our highest quarterly margin of the year, reflecting the impact of our efficiency efforts within the Greenbrook clinics as well as favorable product mix. Operating expenses during the quarter were $26.7 million, an increase of $0.4 million, or approximately 1.4%, compared to $26.4 million in 2024. The increase was primarily attributable to the inclusion of Greenbrook's general and administrative expenses of $8.5 million, partially offset by a reduction of R&D expenses.

During the quarter, we incurred approximately $2.2 million of non-cash stock-based expense. Net loss for the quarter was $7.2 million, or $0.10 per share, as compared to a net loss of $12.7 million, or $0.34 per share, in the prior-year quarter. Fourth quarter 2025 EBITDA was negative $4.3 million, as compared to negative $11.0 million in the prior year. Moving to the balance sheet and cash flow. As of 12/31/2025, total cash was $34.1 million, consisting of cash and cash equivalents of $28.1 million and restricted cash of $6.0 million. This compares to total cash of $19.5 million as of 12/31/2024.

Cash provided by operations in the fourth quarter was a positive $0.9 million, representing a continuation of the steady improvement we delivered throughout 2025. To put this in context, our operating cash burn improved sequentially every quarter this year from negative $17.0 million in Q1 to positive $0.9 million in Q4. This progress reflects the compounding effect of our continued revenue growth, expense discipline, revenue cycle management improvements, and operational efficiencies across the business. In March 2026, we amended our debt agreement with Perceptive, which reduces our outstanding debt obligation and interest expense. Under the amendment, we made a one-time principal payment of $5.0 million to Perceptive, along with adjustments to the existing covenants. Now turning to guidance.

For the full year 2026, we expect total revenue of between $160 million and $166 million, with the midpoint of that range representing greater than 9% growth versus 2025. We expect to see strong revenue performance in our clinic business, with growth year over year in the double digits to mid-teens. For the NeuroStar business, we see increased momentum driving revenue growth year over year in the low to mid-single digits. For the first quarter 2026, we project revenue of between $33 million and $35 million. We expect full-year gross margin to be between 47% and 49%. This reflects the impact of efficiency efforts within our clinic network as well as product mix associated with higher clinic revenue growth.

As we drive revenue growth, we remain highly focused on operating efficiency. We expect operating expenses of between $100 million and $105 million for the full year, inclusive of approximately $8.5 million of non-cash stock-based compensation. This total includes investments and costs associated with efficiency efforts primarily in 2026. We expect to see the full benefit of these efforts by the end of the third quarter, with operating expenses at an annualized run rate of less than $100 million by the fourth quarter 2026. For the full year 2026, we expect cash flow from operations to be between negative $13 million and negative $17 million.

This includes the necessary investments in efficiency, particularly in 2026, to continue our efforts to drive towards sustainable operating cash flow. Similar to last year, we expect our operating cash burn will be highest in the first quarter due to seasonality of both businesses, where we typically see our lowest patient volumes and lowest capital revenues. Additionally, the first quarter is when we see higher annual cash outlays, such as licenses and incentive compensation. Operating cash flow is projected to improve significantly beginning in the second quarter and then sequentially through the remainder of the year, with operating cash flow being positive during the second half of the year.

I will now turn it back to Keith for his closing remarks.

Keith J. Sullivan: Thank you, Steve. I would now like to spend a few minutes on multiple meaningful opportunities ahead of us in 2026. We have spent the last year proving that our integrated model works. We now have a national platform with over 420 BMP accounts and Greenbrook locations across 49 states, a proven playbook for launching therapies in clinic-based settings, deep relationships with primary care physicians, and an infrastructure that gets stronger with every patient we treat. As we move into 2026, we are focused on leveraging that platform to drive the next phase of growth through two key initiatives. First, we are expanding how we bring NeuroStar TMS systems to market.

As we continue to analyze the TMS market, we have determined that different customers want to acquire access to our technology in different ways. We are piloting new models to meet these customers' needs, allowing them to utilize NeuroStar TMS in a way that works best for them. We are testing these approaches during the first quarter and will provide updates throughout the year on their progress. We have expanded our capital sales team to help target and capture these opportunities. Second, we will continue to see strong growth in demand for depression treatment at our Greenbrook clinics. We now know that a significant unmet need remains.

There are approximately 4 million patients with treatment-resistant depression, or TRD, in the United States, and individuals who have failed two or more antidepressants have limited effective options. NeuroStar TMS and SPRAVATO are both important therapies for many of these patients, but the vast majority of the TRD population remains undertreated, and we believe new therapy options can help us reach more of these patients. That is why we are excited to continue to advance our collaboration with COMPASS Pathways on COMP360 psilocybin, a potentially transformational new treatment for TRD. We believe that this could represent one of the most meaningful developments in mental health treatments in decades.

COMPASS has recently completed two Phase 3 studies demonstrating highly statistically significant and clinically meaningful results, including durable improvement through at least 26 weeks after just one or two doses. COMPASS plans to submit an NDA, with the potential for an FDA decision by year end. Our Greenbrook clinics are uniquely positioned to be the leader in offering new therapies like this. We already serve a large TRD population across our network, and we believe a new FDA-approved option has the potential to drive increased awareness and engagement from both patients and referring providers.

Through our experience integrating and scaling SPRAVATO across the Greenbrook network, we have built a proven playbook for launching REMS-compliant therapies, those requiring enhanced safety protocols and administration in clinic-based settings. We have a national footprint, experienced staff, and an operational infrastructure to support a launch, and because of the alignment with our existing SPRAVATO operations, we expect only limited incremental investment to support this new modality, if approved. Through our existing collaboration with COMPASS, we are preparing to commercially offer this treatment upon an FDA approval. We have identified the initial centers for the rollout, and we are working closely with COMPASS to align launch plans and to support the establishment of favorable coverage policies with payers.

We see this as a natural extension of what we have built, further expanding Greenbrook's care platform to deliver innovative treatments to patients who need them most. Beyond treatment-resistant depression, we are also excited about the broader promise of psychedelic-class treatments, which have the potential to help patients suffering from PTSD, generalized anxiety disorder, and other serious conditions. We want Greenbrook to be the platform that can serve all these patients, and our track record of launching and scaling treatments across a national clinic network gives us confidence that we can deliver on that vision. We are excited to share more as we get closer to the potential launch in 2027.

Before we open for questions, I want to take a moment to reflect on my time at Neuronetics, Inc. When I joined over five years ago, we were a single-product company with a bold vision. Today, we are a vertically integrated mental health platform with a national clinic network, a growing base of committed NeuroStar providers, and a pipeline of potential new treatment modalities on the horizon. None of that happens without this team. The people at Neuronetics, Inc. and across the Greenbrook clinics show up every day with a commitment to patients.

I am proud of what we have built together, and I am proud of the difference we are making in the lives of patients and providers across the country. I leave this company in a position of strength and in very capable hands with Dan. I believe the best is truly ahead for Neuronetics, Inc. With that, I would like to turn the call over to the operator for questions.

Operator: Thank you. To withdraw your question, please press 11 again. We will now open for questions. Our first question is from William John Plovanic with Canaccord. Your line is now open.

William John Plovanic: Hey, great. Thanks. Good morning, and thanks for taking my question. So first of all, Keith, congratulations on your retirement, on significant transformation of a business. I think this was $50-ish million in revenues when you took over five years ago, and just adding Greenbrook and the scale and finally hitting that targeted cash flow positive, you know, it is definitely a hard-fought battle, but one, and congratulations. I have three questions. One of them is simple. So just, you know, one, I am going to start with the tough one. Just any granularity, color you can provide on the CID in Florida and this Michigan and what documents they are really asking for, and is this related to Greenbrook?

Steven E. Pfanstiel: Bill, that is an investigation that is ongoing at the moment. What we can say about it is that we are providing all of the information to the U.S. Attorney's Office in the Middle District of Florida. They have requested documentation for billing practices prior to the acquisition of our acquisition of Greenbrook, and we are cooperating fully with them.

William John Plovanic: Okay. Thank you. And then just secondly, on this SPRAVATO, thanks for the update. You know, on the COMP360, just if you could give us any feeling for difference in time the patients have to be in the facility post-treatment or delivery of medication, and then, you know, any difference in the profitability. Like, is it going to be shorter and more profitable, or the patient hangs out longer and it is less profitable per hour, per minute, whatever way you metric you look at. How do we think about that as that rolls out?

Keith J. Sullivan: Bill, we have asked Corey Anderson, who is our Chief Technology Officer and running the Greenbrook side of the business, to join us today. So I am going to let him answer that question for you.

Corey Anderson: Good morning, Bill, and thank you for the question. So COMP360 is administered in supervised doses within the clinic setting, so there is not a daily or recurring protocol. Unlike these daily medications, the treatment effect appears to be durable after just one or two administrations. So if it is approved, COMP360 would be administered under a REMS protocol requiring certified health care settings, trained staff, and patient monitoring, very similar to what we are currently doing with SPRAVATO.

Steven E. Pfanstiel: Yeah, Bill, this is Steve. Just to add, you asked about the economics. We are working closely with COMPASS to look at reimbursement and understand that as we get closer to launch. So more to come on that piece, but I would view it similar to how we have looked at SPRAVATO A and O and SPRAVATO B and B. You know, if the reimbursement is there, it is a great business, but we are not going to take on business that is not going to be profitable at the end of the day.

I think COMPASS is working hard, and we are working hand in hand with them to make sure we have got adequate reimbursement to make this a profitable business.

William John Plovanic: Great. And then last question, Steve, is you ended the year with $34.1 million, $6.0 million was restricted. Now you paid down $5.0 million to Perceptive. Did that $5.0 million come out of the restricted or the non-restricted? And how do you feel about the cash position given the projected Q1 cash burn?

Steven E. Pfanstiel: Yeah. So it does not come out of the restricted piece. So if you looked at 2025, we had $34 million. If you take that $5 million off, it would be a pro forma cash balance of $29 million. If you look at the midpoint of our operating cash flow guidance, we would still have, call it, $14 million to $15 million of cash at year end, obviously some of that being restricted, but that is a cash balance that we have been comfortable with, especially as we are focused on efficiency, reducing overall expenses, and profitability, especially in the second half of this year.

I think the other benefit of paying that down is we get interest expense reduction from that. We are probably going to save close to $600,000 annually just for that $5 million paydown, and it just optimizes that overall debt balance that we have out there. So net-net, we are comfortable with where we sit, and I think it continues reducing that operating cash flow burden by taking out some interest.

William John Plovanic: Great. Thanks for taking my questions.

Operator: Thank you. Our next question is from Adam Maeder with Piper Sandler. Your line is open.

Adam Maeder: Hi. Good morning, Keith and Steve. And, Keith, wishing you all the best in the next chapter. A couple of questions from me. I guess I wanted to start on the guidance front and just double click on the 7% to 11% top-line guidance for the overall business. If I heard correctly, double digits to mid-teens growth for the clinic, low to mid-single-digit growth for standalone. Can you just help us understand within the clinic how much is coming from SPRAVATO, and then on the NeuroStar or standalone side of things, volume versus capital? And then I had a couple of follow-ups.

Steven E. Pfanstiel: Yeah, thanks, Adam. I will give a little bit of commentary on that. On the clinic side, we expect the majority of the growth to come from the volume side of it, although in Q1, in particular, we will have a lot of SPRAVATO growth due to BNB. So as you recall, we really did not have buy-and-bill volume in 2024, and it was actually pretty limited in Q1 of this past year. In fact, we kind of stabilized more in Q2 of last year at about one out of every seven SPRAVATO treatments being buy-and-bill, but prior to that, in Q1, it was still very limited.

So I think what you will see on the growth is Q1 driven by that SPRAVATO BNB impact. Once we get into Q2, it is annualizing, and from that point forward, really, it is about just volume growth overall. SPRAVATO growth, I think, will be volume growth that will be higher than in TMS in general, but we have not broken out that growth rate. Maybe just to give you a flavor, SPRAVATO was probably 30% of our treatment at the start of 2025. It was about 35% by year end 2025. I would expect to see that pattern continue of SPRAVATO representing more of that treatment volume on a quarter-over-quarter basis throughout 2026. It is just a significant growth.

I think the thing to remember about SPRAVATO in particular is once you start a patient and they respond, they stay on maintenance therapy long term, whereas with TMS, it is a course of 36 treatments, they are done, and they will come back only if they need to. So it is a little different cadence of how those patients build over time, but SPRAVATO certainly has that continuing maintenance therapy that patients stay on long term. On the NeuroStar side, to give a little bit of color there, Keith mentioned that we do have additional capital reps. We have been generally at around 40 capital shipments a quarter, a little less in Q1, a little higher in Q4.

We would expect that to increase to as much as 45 or more as their impact is felt over time. So I think it will take a little bit of time for those reps to get up and running, and then the guidance we gave really, because our treatment session is just the biggest segment of the business, we would expect growth there to largely match the overall guidance of what we gave for the NeuroStar side of the business.

Adam Maeder: That is great color. Appreciate that, Steve. And for the follow-up, I actually wanted to ask about Q1 guidance. The Street was a little bit higher than where you have guided to for the first quarter, maybe some mismodeling on our part. But can you just talk about the trends in the business quarter to date? And are you seeing anything that has maybe deviated from past trends? I would just love some incremental color for the first couple of months of the year.

Steven E. Pfanstiel: Thanks. I will give a couple of comments there. Certainly, one is we are still just over a year into the Greenbrook acquisition. A big piece of what we have come to understand is that there is seasonality in the business itself, and we find in November and December we see new starts come down on the clinic side of the business. That is just holiday impact. So that kind of works its way through the first part of Q1 here. We tend to have a little bit of that negative seasonality impacting us in Q1. If you look at the overall level of revenue, clinic seasonality is meaningful.

It is not uncommon for us to see a huge swing between Q1 and Q4. That is a big piece of that. I would say seasonality also impacts us on the NeuroStar side of the business, especially when you think about capital. Capital is always lighter in Q1 versus Q4. That has to do with how capital budgets are planned in clinics and at our customers. Generally, they are using it in Q4 and using less of it in Q1. Depending on how you look at that, those are two big seasonality impacts.

I think the other thing that has really been an impact here, especially over the last couple of months, we have had some weather impacts, which affects patients being able to get in the clinic. We are going to have some of that every winter, but that is obviously something we have to manage as we think about January, February, March, and some of the storms we have had. So that bleeds into the seasonality that we generally see as we go from Q1, which, again, is always our lowest revenue quarter of the year, to Q4, which is generally the highest.

Adam Maeder: That is helpful. Thanks. I will jump back in the queue.

Operator: Thank you. Our final question is from Daniel Walker Stauder with Citizens. Your line is now open.

Daniel Walker Stauder: Yeah, great. Thanks for the questions. Just first off, Keith, congratulations on a great run. It has been great working with you. So I am sending my congrats and just reiterating everyone else's comments. I guess, first, on the COMPASS collaboration, you know, that is really positive news, and I know we have talked a bit about this new wave of therapeutics and the potential role Neuronetics, Inc. could play here, but I was hoping you could give us any more color on this agreement specifically. It sounds like you will be the preferred provider, but is there any exclusivity involved at this point? And if not, could there be in the future? Thanks.

Corey Anderson: Yeah, thanks for the question. So, you know, Greenbrook has been working with COMPASS over the past three years, and we have continued to advance that collaboration to help them with their preparations for commercial launch. We anticipate through the course of this year we will have continued discussions about our preparations as an organization to launch the therapy. As you are probably aware, our CMO, Dr. Jeff Grammer, participated in a COMPASS-hosted webinar in January, and we have laid out our operating plans to be prepared for the launch next year. As to the point of exclusivity, COMPASS has about seven of these strategic collaborations to help them prepare for commercial readiness, and Greenbrook is one of them.

Daniel Walker Stauder: Great. Appreciate it. And just following up on that, staying with COMPASS, you know, it sounds like there should not be too much more of a lift, but, you know, beyond having to update some of your workflow maybe, are there any other updates you need to make, such as personnel or anything physical to your clinics? I am really just trying to get more of an appreciation of how seamlessly this could integrate into the current infrastructure you have. Thank you.

Corey Anderson: Yeah. So, as you are aware, we operate about 84 SPRAVATO clinics under this REMS framework across the country, and I think our infrastructure and experience in running these SPRAVATO clinics provides three key advantages for Greenbrook. First, our clinical staff is experienced in both administering and monitoring these patients under treatment. Second, we have a significant infrastructure and investment in the back-office support of benefits investigations, prior authorizations, and ultimately helping patients access care. And third, we have a deep network of referring providers, psychiatrists, primary care doctors, and others that refer their patients to Greenbrook for these treatments.

So I think the infrastructure is largely there, and we will be able to provide COMP360 treatments within the clinics and with the staff already in place at Greenbrook.

Daniel Walker Stauder: Appreciate that. Just one final one from me on the SPRAVATO rollout. It sounds like you are nearly complete with all the 89 sites, but I just wanted to ask on the utilization of SPRAVATO for these newer converted clinics. How quickly has this ramped once it is available? Is it weeks, months, quarters? Just trying to get a sense of some of these utilization trends. Thank you.

Steven E. Pfanstiel: We look at our utilization, our marketing, and our conversion rates on a daily basis. We are able to identify where we need to add SPRAVATO and where we do not. So in the five locations that are remaining, we are building up that marketing presence there to be able to hit the ground running. We are very comfortable with each one of our locations generating SPRAVATO at the proper level and with the proper billing process, either buy-and-bill or administer-and-observe.

Daniel Walker Stauder: Great. Appreciate it, guys. Thank you.

Operator: Thank you. I would now like to turn the call back over to Keith for closing remarks.

Keith J. Sullivan: Thank you, operator. Thank you all for your interest in Neuronetics, Inc. I really appreciate your support over the last five and a half years while I have been here. It has been a pleasure working with our three analysts and all of the investors. I look forward to hearing the updates on the Q1 call and getting you updated at that point. Thank you all.

Operator: This concludes today's conference call. Thank you for participating, and you may now disconnect.

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