Biodesix (NASDAQ:BDSX) reported fourth-quarter and full-year 2025 results that management said reflected progress on its priorities of accelerating revenue growth, improving operational leverage, and advancing a diagnostic pipeline aimed at supporting future expansion.
Fourth-quarter growth and margin expansion
Chief Executive Officer Scott Hutton said the company’s top-line growth accelerated in the fourth quarter, with revenue up 41% year over year. Chief Financial Officer Robin Harper-Cowie reported total revenue of $28.8 million for the quarter and $88.5 million for the full year, representing increases of 41% and 24%, respectively.
Lung diagnostics: volume growth, primary care expansion, and reimbursement gains
Lung diagnostics remained the company’s largest business line. Harper-Cowie said lung diagnostics revenue was $25.1 million in the fourth quarter and $79.2 million for fiscal 2025, up 46% and 22% year over year. Excluding claims older than one year, fourth-quarter lung diagnostics revenue was $24.1 million, which she described as “core organic growth of 40%” versus the prior-year quarter.
Test volumes were 18,000 in the fourth quarter and 62,600 for the year, increasing 23% and 15%, respectively. Management said higher average revenue per test contributed to the revenue growth, driven by “advancements in reimbursement” that began in the third quarter through improved payer coverage and revenue cycle management. Harper-Cowie also noted approximately $1 million of fourth-quarter collections from claims older than one year.
Hutton described a three-tier commercial strategy in lung nodule management that began with interventional pulmonologists, expanded into general and community pulmonology, and in 2025 selectively expanded into primary care referral networks. He said the approach is intended to help physicians triage lung nodule patients by malignancy risk and prioritize higher-risk patients for diagnostic intervention while allowing lower-risk patients to be managed through surveillance.
Hutton said customer response has been positive, with growth coming from both pulmonology and primary care channels. Primary care volumes accounted for 12% of total Nodify test volume in the fourth quarter, growing 67% versus the fourth quarter of 2024, while pulmonology volumes increased 26%, he said. The company ended the quarter with 97 sales representatives active in the field, which management said supported delivery of 18,000 tests in the period.
Development services partnerships and pipeline priorities
Beyond clinical testing, Biodesix highlighted growth in its development services business. Harper-Cowie reported development services revenue of $3.6 million in the fourth quarter and $9.3 million for fiscal 2025, increases of 12% and 41%, respectively, driven by deliveries against contracted work and new agreements. She said Biodesix entered 2026 with $11.8 million of contracted business.
Hutton pointed to two partnerships announced during the year: one as a “center of excellence” for Thermo Fisher Scientific and another with Bio-Rad Laboratories. He said Biodesix and collaborators, including Memorial Sloan Kettering Cancer Center, presented on the partnerships and shared pipeline insights at the Association for Molecular Pathology annual meeting in December.
Management outlined several areas within its development pipeline, including:
- An MRD test combining proteomic information from the company’s Risk of Recurrence test with tumor-informed genomics using multiplex droplet digital PCR for disease monitoring.
- Expansion of the VeriStrat test into immunotherapy selection in additional tumor types, including colorectal cancer.
- Expansion of VeriStrat in prostate cancer to predict likelihood of response to standard-of-care hormone therapy.
- An ESR1 genomic test available to help guide treatment in breast cancer.
- AI-based digital diagnostics intended to initially supplement existing on-market lung disease tests.
On the Q&A portion of the call, Hutton said the company is not planning to commercialize the pipeline tests within the next 12 months, citing a focus on profitability and an intention to avoid launching “no-pay tests” without appropriate reimbursement timing and supporting studies.
Profitability milestone, cash position, and 2026 outlook
Harper-Cowie reported a net loss of $4.0 million for the fourth quarter and $35.3 million for fiscal 2025, improvements of 52% and 18% from the prior-year periods. Adjusted EBITDA was positive $530,000 in the quarter—Biodesix’s first positive Adjusted EBITDA quarter—while full-year adjusted EBITDA was a loss of $17.5 million, improving 21% from 2024.
The company ended the quarter with $19.0 million in unrestricted cash and cash equivalents, up 14% from the third quarter, including $2.3 million in at-the-market proceeds. Harper-Cowie said pro forma cash and cash equivalents were $33.7 million, including subsequent at-the-market proceeds, and noted that after quarter-end Biodesix raised an additional $14.7 million via the ATM. She also said the company amended its senior secured term loan with Perceptive Advisors to extend the maturity date and interest-only period to November 2028.
For 2026, Biodesix guided to annual revenue of $106 million to $112 million, which management said implies 23% growth at the midpoint compared with 2025, along with “continued improvement towards sustained Adjusted EBITDA positivity.” Harper-Cowie said the guidance reflects typical seasonality and recent weather events that can affect first-quarter performance, while emphasizing that fourth-quarter results included $1 million in collections from claims older than one year and that investors should consider revenues excluding that amount when comparing the first quarter to the fourth quarter.
Management attributed expected 2026 growth to increased tenure of the expanded sales force, improvements in average revenue per test demonstrated in the second half of 2025, additional clinical data supporting Nodify Lung adoption with providers and payers, growth in the development services pipeline, and operating leverage.
About Biodesix (NASDAQ:BDSX)
Biodesix, Inc is a commercial-stage molecular diagnostics company headquartered in Boulder, Colorado, that develops and delivers blood-based tests to improve the diagnosis and management of lung diseases, including lung cancer. The company integrates advanced proteomic and, more recently, genomic technologies to offer noninvasive testing solutions designed to guide clinical decision-making. Biodesix operates a CLIA-certified and CAP-accredited laboratory, allowing it to process patient samples at scale and maintain rigorous quality standards.
The company’s flagship product, VeriStrat®, is a proteomic test that stratifies patients with non-small cell lung cancer into groups more likely to benefit from specific therapies.
