MALVERN, PA — Neuronetics, Inc. (Nasdaq: STIM) reported higher fourth-quarter and full-year 2025 revenue, narrowed its losses, posted positive operating cash flow in the fourth quarter, and said Dan Reuvers will become president and chief executive officer on March 23.
The Malvern-based company said fourth-quarter revenue rose 86% to $41.8 million from $22.5 million a year earlier, driven primarily by its December 2024 acquisition of Greenbrook TMS Inc. On an adjusted pro forma basis, which assumes Greenbrook was included in both periods, fourth-quarter revenue increased 23%.
Greenbrook clinic revenue totaled $23.5 million in the quarter, up 428% as reported and 37% on an adjusted pro forma basis, the company said.
U.S. NeuroStar Advanced Therapy System revenue increased 15% to $4.4 million in the quarter, with 49 systems shipped.
U.S. treatment session revenue fell 4% to $12.4 million from $12.9 million in the fourth quarter of 2024. The company said the decline reflected the absence of $1.2 million in treatment session revenue from Greenbrook, while adjusted pro forma treatment session revenue increased 6% from $11.7 million.
Gross margin in the fourth quarter was 52.0%, down from 66.2% a year earlier, which the company attributed primarily to the inclusion of Greenbrook’s clinic business.
Operating expenses rose 1.4% to $26.7 million from $26.4 million in the year-earlier quarter, mainly because of Greenbrook-related costs, partially offset by lower research and development spending.
Net loss for the quarter narrowed to $7.2 million, or $0.10 per share, from $12.7 million, or $0.34 per share, in the fourth quarter of 2024.
Neuronetics said cash provided by operations was $0.9 million in the fourth quarter, which CEO Keith Sullivan said reflected the company’s focus on growth, operating discipline and cash collection.
For the full year, revenue rose 99% to $149.2 million from $74.9 million in 2024. On an adjusted pro forma basis, full-year revenue increased 15%, the company said.
Full-year Greenbrook clinic revenue was $87.0 million, up 1,857% as reported and 28% on an adjusted pro forma basis.
U.S. NeuroStar system revenue for 2025 declined 7% to $14.3 million from $15.3 million, with 161 systems shipped. The company said the decline was consistent with its focus on higher-volume accounts.
U.S. treatment session revenue for the year fell 15% to $43.3 million from $50.8 million. Neuronetics said the decrease was primarily due to the absence of $8.2 million in treatment session revenue from Greenbrook, while adjusted pro forma treatment session revenue rose 1.7% from $42.6 million.
Gross margin for the year declined to 48.5% from 72.3%, again reflecting the addition of Greenbrook’s clinic business.
Operating expenses for 2025 increased 16.9% to $103.7 million from $88.7 million, driven mainly by Greenbrook-related expenses, partially offset by lower general, administrative, sales and marketing costs.
Full-year net loss narrowed to $39.1 million, or $0.59 per share, from $43.7 million, or $1.38 per share, in 2024.
As of December 31, 2025, the company held $34.1 million in total cash, including $28.1 million in cash and cash equivalents and $6.0 million in restricted cash, compared with $19.5 million a year earlier.
In March 2026, Neuronetics amended its agreement with Perceptive Advisors LLC, making a one-time principal payment of $5.0 million and revising existing covenants. The company said the amendment lowers its outstanding debt obligation and ongoing interest expense.
Neuronetics said it expects first-quarter 2026 revenue of $33 million to $35 million.
For full-year 2026, the company forecast revenue of $160 million to $166 million, gross margin of 47% to 49%, operating expenses of $100 million to $105 million, including about $8.5 million in stock-based compensation, and operating cash flow between negative $13 million and negative $17 million.
The company said it expects operating expenses to decline in the second half of 2026 as efficiency measures take hold, with fourth-quarter 2026 operating expenses projected to be below $100 million on an annualized basis.
Neuronetics also announced that Reuvers will succeed Sullivan as president and CEO effective March 23. Sullivan will retire March 31.
Reuvers most recently served as president and chief executive officer of Tactile Medical, where the company said he increased revenue while delivering record earnings and cash flow.
“A year ago, we set out to build a vertically integrated mental health company,” Sullivan said. “We exited the year with positive operating cash flow in the fourth quarter.”
The company also said it continued advancing its collaboration with Compass Pathways on COMP360 psilocybin for treatment-resistant depression.
In addition, Neuronetics said TRICARE West expanded coverage for transcranial magnetic stimulation therapy, including NeuroStar Advanced Therapy, to adolescents age 15 and older with depression across 26 states.
Neuronetics develops and markets the NeuroStar Advanced Therapy System and operates Greenbrook treatment centers in the United States.
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