Lucid Diagnostics (NASDAQ:LUCD) reported higher fourth-quarter 2025 EsoGuard testing volume and revenue and highlighted progress on reimbursement initiatives, including a new U.S. Department of Veterans Affairs (VA) contract and ongoing discussions with Medicare and commercial payers.
Fourth-quarter test volume exceeded company’s target range
Chairman and CEO Dr. Lishan Aklog said fourth-quarter EsoGuard test volume totaled 3,664, above the company’s stated target range of approximately 2,500 to 3,000 tests per quarter. The result was a 29% increase from the third quarter of 2025.
In the Q&A, management said the sequential increase in volume was not attributable to VA testing, which is still in the early stages at individual VA centers. Aklog said the increase was more reflective of improved field productivity and continued progress in shifting commercial efforts toward Medicare and VA populations while maintaining overall volume.
VA Federal Supply Schedule contract established Medicare-aligned pricing
Aklog described the VA contract as a key milestone, stating Lucid was awarded a contract for EsoGuard under the VA Federal Supply Schedule (FSS), which centralizes ordering and sets pricing aligned with the company’s established Medicare rate of $1,938. He said securing the contract without discounting relative to Medicare was an important validation of the company’s clinical evidence.
Management emphasized the VA’s scale—about 170 medical centers and approximately 9 million enrolled veterans annually—and characterized veterans as a clinically relevant population with higher risk of GERD and esophageal disease. Aklog said the company believes a significant portion of VA patients will meet guideline-based risk factors for esophageal precancer testing.
On rollout, Aklog said the company is building a pipeline of engagements with individual VA centers and has appointed a senior commercial leader as a national director for VA efforts, working with the vice president of market access. He added that Lucid is reallocating existing commercial resources rather than increasing headcount, citing focus on cash burn and operating expenses.
Asked about market size, Aklog estimated that “at least a couple million” of the 9 million VA patients could meet conservative guideline criteria for testing, translating into an addressable market when multiplied by the Medicare rate.
Real-world study in nearly 12,000 patients highlighted performance and scalability
Lucid also discussed positive results from what it called the largest reported real-world experience of esophageal precancer testing, evaluating EsoGuard and EsoCheck in nearly 12,000 at-risk patients. Aklog said the manuscript is in peer review for publication and that the data has been useful in payer discussions.
Key metrics cited on the call included:
- 95% technical success rate for EsoCheck cell collection
- 95% of procedures completed in under 2 minutes
- 100% safety, according to management’s description
Aklog contrasted procedure time and safety with “sponge-based capsule devices,” which he described as taking at least 10 minutes and having had Class I recalls in the past. He said the real-world dataset supports scalability and “preparedness for broad access.”
Medicare LCD timeline and commercial payer pathway updates
On Medicare, Aklog said the company continues to await publication of a draft local coverage determination (LCD) and expressed confidence that the process is close, attributing the delay to logistics rather than a negative view of the evidence. He referenced the September 2025 Contractor Advisory Committee (CAC) meeting and said the clinicians involved “unequivocally” supported the clinical validity and utility evidence presented.
Management outlined the remaining steps once a draft LCD is issued: a 45-day public comment period (including a public meeting), followed by a final LCD and Federal Register notice. Aklog said that once final coverage is in place, Lucid would be eligible for payments on Medicare claims dating back one year.
On the commercial side, Aklog described what he characterized as “very positive engagements” with multiple large payers. He highlighted UnitedHealthcare’s endoscopy guidelines, which state a positive EsoGuard test is an appropriate indicator for EGD coverage in this setting. While not describing it as an explicit positive coverage policy for EsoGuard, Aklog said the company views the change as “de facto coverage” and has initiated credentialing to become an in-network provider, with the intention of moving to contracting discussions afterward.
Aklog also said Lucid is pursuing similar pathways with other payers where possible and continues engaging laboratory benefit managers (LBMs), noting that commercial payers evaluate cost-effectiveness and that Lucid is supplementing existing data with additional modeling. He said the company believes it has secured its first positive LBM policy but did not disclose details, indicating it would be announced after it is posted publicly.
Financial position, burn rate, and share count updates
McGrath reported year-end cash of $34.7 million. He said the average 2025 burn rate, including cash interest, was $11.1 million per quarter, with the fourth quarter slightly higher due to roughly $500,000 of investments in sales team and market access staffing and the settlement of certain annual compensation obligations.
He reviewed the company’s debt refinancing completed at the end of 2024 into a $22 million five-year convertible note, interest-only at 12% with a $1 conversion price, held by long-term shareholders. McGrath said the fair value of convertible notes was $24 million at year-end, and that quarterly mark-to-market adjustments contributed to non-cash expense items.
On share count, McGrath said shares outstanding, including unvested restricted stock awards and the conversion of Series B preferred “as of last week,” were approximately 177 million. He added that after the March 13 conversion of Preferred Series B, about 13 million shares were held in abeyance due to ownership blockers; if issued, common shares outstanding would be about 190 million. He also noted GAAP shares outstanding at December 31 were 131 million and do not reflect unvested RSAs.
McGrath said PAVmed remained the largest common shareholder at about 18% ownership and that, while it no longer has voting control, PAVmed together with the board and management has approximately a 25% voting interest. He also said Lucid Series B-1 preferred securities are scheduled to convert on May 6, with an additional 16.8 million shares to be issued including dividends, subject to the ownership blocker.
On expenses, McGrath said non-GAAP operating expenses rose to $48.7 million in 2025 from $44.3 million in 2024, driven by higher commercial expense from added sales personnel and market access staff, as well as higher G&A including financing costs and compensation. He said non-GAAP net loss per share was $0.10 for the fourth quarter and $0.43 for the year, which he said was “better by almost half” versus 2024.
Management reiterated that broader reimbursement remains central to scaling the business and said it expects the VA and Medicare to be primary near-term drivers as coverage and contracting progress.
About Lucid Diagnostics (NASDAQ:LUCD)
Lucid Diagnostics is a molecular diagnostics company focused on improving early detection of oral and oropharyngeal cancers. The company’s flagship offering, the LucidDx Oral Cytology Brush Test, combines a minimally invasive brush biopsy tool with proprietary laboratory analysis to identify cellular abnormalities indicative of malignancy. Samples collected in dental and medical offices are sent to Lucid’s CLIA-certified and CAP-accredited laboratory, where advanced imaging and cytopathology workflows generate diagnostic reports for clinicians and patients.
Since commencing commercial operations, Lucid Diagnostics has worked to integrate its testing platform into dental practices, oral surgery clinics and ENT specialists across the United States.
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