SI-BONE outlines 18%–20% revenue growth target for 2025 with platform expansion, eyes positive free cash flow in 2026

Earnings Call Insights: SI-BONE, Inc. (SIBN) Q3 2025

MANAGEMENT VIEW

* Laura Francis, CEO, reported "another quarter of robust revenue growth, achieved sustained adjusted EBITDA profitability and reached a major milestone in delivering positive operating cash flow." She highlighted worldwide revenue of $48.7 million, representing approximately 21% growth, and referenced strong U.S. revenue growth to $46.4 million, "driven by growing adoption of our solutions."
* Francis detailed successful commercialization of iFuse-TORQ in Europe and progress on two new products expected to launch in 2026: "We recently filed the 510(k) application for our next-generation technology... we anticipate launching this product in the first quarter of 2026."
* She noted, "Our interventional case volume doubled compared to Q3 2024 as physicians recognize the value of our clinically validated solutions and comprehensive commercial expertise."
* Francis emphasized the "record number of physicians we added in the quarter" and stated, "The number of procedures using more than 2 Granite implants per case grew approximately 40% in the quarter."
* Anshul Maheshwari, CFO, stated, "Our worldwide revenue was $48.7 million in the third quarter, representing growth of 20.6%. U.S. revenue was $46.4 million, representing 21.2% growth, driven by procedure volume growth of over 22%."
* Maheshwari reported, "Our gross profit was $38.8 million, an increase of $6.9 million or 21.8%. Gross margin was 79.8%, expanding by 75 basis points year-over-year."
* Maheshwari added, "Our net loss narrowed to $4.6 million or $0.11 per diluted share compared to a net loss of $6.6 million or $0.16 per diluted share. We delivered positive adjusted EBITDA of $2.3 million for the quarter, which translates to an adjusted EBITDA margin of approximately 5%."
* Maheshwari also reported, "We were breakeven on a net cash flow basis and ended the quarter with $145.7 million in cash and marketable securities... generating $2.3 million cash from operating activities."

OUTLOOK

* Maheshwari announced, "We're updating our full year revenue guidance to range between $198 million to $200 million. This implies year-over-year growth of approximately 18% to 20% as compared to the previous guidance of approximately 17% to 18%."
* He added, "Given the durability of our gross margin, we are now expecting the full year gross margin to be at 79.5%. We're maintaining our annual operating expense growth guidance at 10% at the midpoint of the revenue range."
* Francis commented, "Going into 2026, we're confident in our ability to sustain strong top line growth, expand margins and inflect on free cash flow."

FINANCIAL RESULTS

* SI-BONE reported worldwide revenue of $48.7 million and U.S. revenue of $46.4 million for Q3 2025.
* Gross profit was $38.8 million with a gross margin of 79.8%.
* Net loss narrowed to $4.6 million or $0.11 per diluted share, with positive adjusted EBITDA of $2.3 million for the quarter.
* SI-BONE ended the quarter with $145.7 million in cash and marketable securities, achieving positive cash flow from operating activities for the first time.
* Year-to-date net cash consumption was $4.3 million compared to $15.2 million in the prior year period.

Q&A

* Patrick Wood, Morgan Stanley: Asked about physician density and operating leverage. Francis replied that "only around 25% of our SI joint surgeons are currently performing another procedure type" and highlighted the opportunity to "significantly increase physician density in the coming years." Maheshwari added, "If you look at the midpoint of our guide for the revenue and OpEx growth for the year, you're sort of tracking to about 1.9x operating leverage at that midpoint."
* Caitlin Cronin, Canaccord Genuity: Questioned the raised guidance and cash burn expectations. Maheshwari stated, "We do expect to use a little bit of cash in the fourth quarter... building up surgical capacity, and also building up some capacity for the new product that Laura has talked about."
* Matthew O'Brien, Piper Sandler: Asked about growth expectations for 2026 and gross margin durability. Francis said they "feel pretty comfortable with where the current consensus is at" for 2026 and identified reimbursement changes and international growth as tailwinds. Maheshwari noted, "Over the medium term, we now expect gross margins to sort of stabilize around that 78%, 78.5% area."
* Gracia Mahoney, BofA: Inquired about territory increases. Francis explained a hybrid model and noted "88 as of the end of the third quarter" territory managers. Maheshwari added, "We want to get to 100 territories over the next 12 to 18 months."
* Young Li, Jefferies: Asked about surgeon additions and pipeline impact on TAM. Francis described "broad-based growth" and stated, "The second product that we're going to launch in 2026... really does have a significant impact on growing the TAM even further."
* Ross Osborn, Cantor Fitzgerald: Asked about ASP trends and TORQ European launch. Maheshwari said ASP was "quite stable... seeing good traction in Granite, especially with multiple implant cases."
* David Saxon, Needham: Inquired about TNT NTAP and profitability. Francis confirmed NTAP effective October 1, "around $4,100... up to 30% improvement in reimbursement." Maheshwari outlined their asset-light model and operating leverage.
* Ravi Misra, Truist: Asked about EBITDA inflection and interventionalist growth. Maheshwari said leverage should be "a little bit on the lower end" in 2026, increasing as new products ramp. Francis noted the additive opportunity with interventionalists and highlighted the CMS-proposed 17% reimbursement increase for office-based SI joint fusion procedures.

SENTIMENT ANALYSIS

* Analysts pressed on drivers of guidance, sustainability of growth, and profitability, with a generally positive but probing tone, as seen in questions about growth targets, operating leverage, and cash flow.
* Management maintained a confident, upbeat outlook, with Francis frequently referencing momentum and growth opportunities. Maheshwari's tone was measured but optimistic, citing, "We're proud to have achieved another major cash flow milestone..."
* Compared to the previous quarter, analyst sentiment remained positive but more focused on the sustainability of growth and profitability milestones, while management’s tone shifted from cautious optimism to greater confidence, especially regarding cash flow and margin durability.

QUARTER-OVER-QUARTER COMPARISON

* Guidance for full-year revenue was raised from $195–$198 million (Q2) to $198–$200 million (Q3), reflecting higher growth expectations.
* Gross margin guidance increased from 78.5%–79% to 79.5%.
* Cash flow improved from breakeven in Q2 to positive operating cash flow in Q3.
* The number of active physicians increased from 1,440 in Q2 to 1,530 in Q3, with a record 330 new physicians added in the quarter.
* Product launches and pipeline updates became more prominent, with explicit plans to launch two new products in 2026 and expand territories from 88 to 100.
* Analyst focus shifted more toward the durability of margins and the scalability of the business model, while management expressed increased confidence in achieving positive free cash flow in 2026.

RISKS AND CONCERNS

* Management noted the dynamic nature of gross margins due to new product launches and investment in surgical capacity.
* Operating expenses grew 11.9% this quarter, reflecting growth-related investments and higher commissions.
* Analysts raised concerns about sustainability of growth, gross margin durability, and the ability to efficiently scale territory management.
* Maheshwari addressed the expected use of cash in Q4 for building capacity and inventory, and highlighted plans to self-fund innovation through operating cash flow by 2026.

FINAL TAKEAWAY

SI-BONE management emphasized robust revenue growth, expanding physician adoption, and significant progress toward profitability and positive cash flow. With a raised full-year revenue target of $198–$200 million, ongoing product innovation, and strategic expansion of the commercial platform, the company expressed strong confidence in sustaining double-digit growth and achieving positive free cash flow in 2026, positioning itself for continued market leadership and long-term shareholder value.

Read the full Earnings Call Transcript [https://seekingalpha.com/symbol/sibn/earnings/transcripts]

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