SiBone (NASDAQ:SIBN) executives highlighted record revenue, increased physician adoption, and a shift to profitability metrics in the company’s fourth-quarter 2025 earnings call, while outlining growth initiatives tied to reimbursement tailwinds, new product launches, and an expanded commercial footprint entering 2026.
Fourth-quarter and full-year results
For the fourth quarter ended Dec. 31, 2025, SI-BONE reported worldwide revenue of $56.3 million, up 15% year over year. U.S. revenue was $53.5 million, up 13.9%, which management characterized as coming against a “tough comparable” from the prior year period. International revenue grew 38.8% to $2.9 million, with CFO Anshul Maheshwari citing strong reception for iFuse TORQ.
Profitability improved as the company delivered its first full year of positive Adjusted EBITDA. Gross margin was 79% in the fourth quarter and 79.6% for the full year, with Maheshwari noting the full-year gross margin came in about 200 basis points above the company’s original 2025 guidance. He attributed the outperformance to stable average selling prices from favorable procedure mix and to operational initiatives such as supply chain efficiency and cost optimization.
Operating expenses increased 6.2% in the fourth quarter to $47.0 million and 8.9% for the full year to $182.2 million. Management said the increase was primarily tied to revenue-generating activity, including higher sales commissions, along with increased R&D investment to expand the product pipeline.
Net loss narrowed to $1.6 million, or $0.04 per diluted share, compared with a $4.5 million net loss, or $0.11 per diluted share, a year earlier. For 2025, net loss narrowed 38.8% to $18.9 million, or $0.44 per diluted share.
Adjusted EBITDA was $5.1 million in the fourth quarter, improving 176.2% from the prior year, for a 9.1% margin. Full-year Adjusted EBITDA was positive $8.9 million versus an Adjusted EBITDA loss of $5.1 million in 2024.
Cash flow and liquidity
SI-BONE ended 2025 with $147.8 million in cash and equivalents, up $2.1 million from the third quarter. Management said the fourth quarter was the second consecutive quarter of positive cash flow from operating activities and the first quarter of positive free cash flow. The company generated nearly $500,000 in net free cash flow in the quarter, which Maheshwari said was ahead of its previously stated goal of achieving free cash flow at some point in 2026.
For the full year, cash consumption was $2.2 million compared with $16.0 million in 2024, which the company attributed to disciplined working capital management and an “asset-light” model while continuing to invest in surgical capacity.
Physician adoption, procedures, and commercial execution
CEO Laura Francis said SI-BONE’s proprietary technologies have been used in more than 140,000 procedures worldwide. She also pointed to record customer engagement in 2025, with more than 2,400 U.S. physicians performing nearly 22,000 procedures, representing a 22% increase in U.S. physicians using SI-BONE technologies during the year.
In the fourth quarter alone, a record 1,640 physicians performed procedures using the company’s solutions, an increase of 250 physicians, or 18% growth versus the prior-year quarter. Francis said the quarter marked SI-BONE’s 20th consecutive quarter of double-digit growth in physician adoption and that growth spanned all call points.
On the commercial front, SI-BONE ended the quarter with 89 quota-carrying territory managers. Annual revenue per territory was $2.1 million, up 18% year over year, which management said marked the 13th consecutive quarter of double-digit territory productivity growth. The company’s hybrid model includes a direct sales force and more than 300 third-party agents.
Reimbursement and product updates
Management emphasized reimbursement wins as catalysts for adoption. Francis said the company secured a New Technology Add-on Payment (NTAP) for iFuse TORQ TNT and a transitional pass-through (TPT) payment for iFuse Bedrock Granite.
Francis also discussed site-of-care reimbursement changes going into 2026, including a 17% increase in Medicare reimbursement for office-based lab (OBL) SI joint fusion effective Jan. 1, 2026, which she said brings reimbursement to nearly $14,000. She added that Granite continues to benefit from TPT payment status with a $0 device offset in outpatient and ambulatory surgery center (ASC) settings, and that CMS approved inclusion of the open SI joint fusion code in the TPT calculation effective Jan. 1, 2026.
On products, Francis said the company received FDA 510(k) clearance for INTRA Ti earlier in the month and initiated an “alpha launch” the prior week. She described INTRA Ti as building on the posterior approach used by INTRA X and as backed by established nationwide reimbursement. Management expects adoption to ramp through 2026 as physician education and training scale.
Francis said iFuse TORQ TNT gained momentum in the trauma market, citing a 50% increase in physician adoption in the fourth quarter and noting NTAP reimbursement “up to 30% higher” in eligible cases. She also said the company remains on track to file for 510(k) clearance for its “third Breakthrough Device” in the third quarter, with potential commercialization in late 2026, subject to FDA review timelines.
Internationally, Maheshwari said SI-BONE is working to bring TNT into international markets in late 2026, “well ahead” of its previously planned 2027 launch.
2026 guidance and key themes
For 2026, SI-BONE guided worldwide revenue of $228.5 million to $232.5 million, implying 14% to 16% growth. The outlook assumes high-teens U.S. procedure volume growth and revenue weighted toward the second half of the year. Maheshwari said the company is taking a prudent approach to incorporating tailwinds until they materialize.
Additional 2026 framework items included:
- Gross margin: approximately 78% for the full year.
- Operating expense growth:
- Adjusted EBITDA and free cash flow:
On margin guidance, Maheshwari attributed the expected gross margin step-down primarily to non-cash depreciation tied to investments in surgical capacity, including trays to support the Smith+Nephew partnership, capacity for Granite, and potential capacity needs for a product expected to be commercialized toward the end of 2026.
A major commercial development discussed on the call was SI-BONE’s new strategic partnership with Smith+Nephew to expand reach in pelvic trauma, particularly across level 1 and level 2 trauma centers. Francis said the partnership is intended to broaden access to TORQ and TNT in trauma settings while allowing SI-BONE’s direct sales force to stay focused on spine and interventional call points. In Q&A, management said the agreement was signed the prior week, training and tray placement discussions are underway, and the companies expect to see activity as early as March with capacity ramping in the second and third quarters.
Management also reviewed leadership updates, including Maheshwari assuming the role of Chief Operating Officer in addition to CFO, and the promotion of Jeff Ziegler to Senior Vice President of Market Access and Reimbursement. Francis also noted the completion of a commercial leadership transition with Nikolas Kerr becoming Chief Commercial Officer, while outgoing executive Tony Recupero will remain in an advisory role for 12 months.
About SiBone (NASDAQ:SIBN)
Si-BONE, Inc is a commercial‐stage medical device company focused on the design, development and commercialization of implant systems to treat degenerative conditions of the sacroiliac (SI) joint. Its flagship product, the iFuse Implant System, consists of triangular titanium implants that are inserted via a minimally invasive surgical procedure to stabilize the SI joint and alleviate chronic lower back and buttock pain.
FDA‐cleared in 2012, the iFuse portfolio has expanded to include the iFuse-3D and iFuse-3Di devices, which feature a porous, 3D-printed surface to promote bone ongrowth and biological fixation.
