Myomo (NYSEAMERICAN:MYO) reported fourth-quarter and full-year 2025 results that management said showed progress across its growth, reimbursement, cost, and product development priorities, while also highlighting ongoing headwinds in Medicare Advantage authorizations.
Revenue growth led by recurring sources, O&P, and international
CEO Paul Gudonis said the company’s fourth quarter of 2025 was its strongest revenue quarter of the year, with revenue of $11.4 million. Full-year revenue was $40.9 million, a 26% increase over 2024.
A key theme on the call was the company’s shift toward “recurring patient sources.” Gudonis said recurring sources accounted for 42% of revenue in the fourth quarter of 2025, up from 26% in the fourth quarter of 2024, which he said represented 52% year-over-year growth in recurring-source revenue.
As part of building the O&P channel, Gudonis said Myomo launched a MyoPro Center of Excellence program to educate domestic O&P practices on the MyoPro 2X product and the reimbursement environment. He said O&P providers ordered approximately 100 MyoPros during 2025. CFO David Henry added that the U.S. O&P channel generated a record $1 million in quarterly revenue in the fourth quarter, representing 9% of total revenue and up 81% year-over-year. In the Q&A, management said O&P unit volume in the fourth quarter was about 36 units, and that a “couple of dozen” O&P providers have been trained, certified, and ordering.
International revenue also hit a record, reaching $2.2 million in the fourth quarter, up 46% year-over-year and representing 19% of total revenue, primarily driven by Germany. Gudonis said international revenue exceeded $2 million for the first time and grew 48% for the full year, helped by pipeline growth, more O&P clinics and medical professionals sourcing patients, favorable reimbursement policies from statutory health insurers, and foreign exchange tailwinds. Management said it is adding business development and clinical staff in Germany and expects continued growth there in 2026.
China joint venture paused amid partner bankruptcy
Gudonis said Myomo learned toward the end of 2025 that Ryzur Medical, the majority shareholder in its China joint venture, declared bankruptcy due to financial problems in its core rehabilitation hospital business. As a result, the joint venture’s operations are currently on hold.
Management noted Myomo previously received $2.7 million in upfront license payments and said it is working with China Lead Ventures, an investor in the joint venture, to explore recapitalizing and restructuring the venture to pursue the market opportunity in China.
Payer access expands, but Medicare Advantage remains challenging
Management emphasized progress in contracting with payers. Gudonis said Myomo signed in-network contracts with additional Medicare Advantage and commercial payers in recent months, and highlighted a new multi-state agreement with Elevance Health. He said the agreement covers a network of 45 million lives and allows state-by-state in-network contracts with case-by-case authorization, which he said can reduce reliance on lengthy single-case agreements and speed patient access and the revenue cycle.
Henry said Medicare Part B represented 49% of fourth-quarter revenue, while Medicare Advantage represented 20%. Medicare Advantage revenue in dollar terms fell 11% versus the prior-year quarter. He characterized 2025 as a challenging year with Medicare Advantage payers issuing a high number of pre-authorization denials, requiring appeals to serve patients. While management said more payer contracts are leading to increased authorizations under those agreements, Henry said the volume has not yet replaced the level previously seen from payers that had authorized more routinely.
In the fourth quarter, 69% of revenue came from the direct billing channel, down from 81% in the prior-year quarter. Henry said direct billing revenue declined 20% year-over-year due to lower Medicare and Medicare Advantage authorizations and social media lead generation challenges during the first half of 2025.
Operational metrics, margins, and costs
Henry said Myomo delivered 208 MyoPro revenue units in the fourth quarter, down 5% year-over-year but up 12% sequentially. He noted that 62% of fourth-quarter revenue units were generated from authorizations received during the quarter, and that smoother operations helped drive a record share of “intra-quarter fill units” compared to the prior year.
Average selling price (ASP) decreased less than 1% year-over-year to approximately $54,600, which Henry attributed primarily to channel mix.
Gross margin in the fourth quarter was 68.6%, down from 71.4% a year earlier but up from 63.8% in the third quarter. Henry said the year-over-year decline was driven by a lower amount of overhead capitalized to inventory compared with the prior-year period and higher warranty expenses. For the full year, gross margin was 65.7% versus 71.2% in 2024, which Henry attributed to higher overhead costs, primarily tied to the company’s facility move earlier in 2025.
Operating expenses were $10.6 million in the fourth quarter, up 19% year-over-year, driven primarily by higher sales, clinical, and marketing costs. Henry said advertising expense rose by approximately $1.2 million year-over-year, though it was down 4% sequentially. Operating loss for the quarter was $2.8 million versus about $200,000 in the prior-year quarter. Net loss was $3.8 million, or $0.09 per share, compared with a net loss of $300,000, or $0.01 per share, in the prior-year quarter. Adjusted EBITDA was negative $1.9 million versus positive $200,000 a year earlier.
On liquidity, Henry said cash, cash equivalents, and short-term investments were $18.4 million as of December 31, 2025. He said free cash flow (“cash burn”) was $1.5 million in the fourth quarter, excluding certain financing-related items, and operating cash flow was negative $1.1 million compared with positive $3.4 million in the prior-year quarter.
Product roadmap and 2026 outlook
Gudonis said the company launched the MyoPro 2X in 2025 and continued development work on the next-generation MyoPro 3. He also said Myomo plans to activate its mobile app in the second quarter of 2026; the app is already available as a free download and is intended to enhance user capabilities and data collection while reducing cost of goods sold by eliminating the need to ship a laptop with each device. In the Q&A, Henry said the app could remove roughly $400 to $500 of cost per unit. Management also discussed other cost-reduction projects and said it is targeting a return to gross margin in the 70% range by the time it exits 2026, while noting margins may fluctuate with volume.
Management also discussed an R&D investment in a randomized controlled trial at Craig H. Neilsen Rehabilitation Hospital. Gudonis said the trial’s IRB was approved, it will compare MyoPro patients to a control group, and the company expects initial readouts by the end of 2026. He said the data is intended to support efforts to expand payer coverage by reinforcing that the device is medically reasonable and necessary.
For guidance, Henry said first-quarter 2026 revenue is expected to be $9.0 million to $9.5 million, reflecting seasonal patterns. He said first-quarter operating loss is expected to be higher than the fourth quarter of 2025 due to lower revenue and slightly higher operating expenses. For full-year 2026, management guided to revenue of $43 million to $46 million and said gross margin should benefit from higher volume, lower per-unit cost of goods sold, and a 2% Medicare price increase effective January 1, 2026.
Henry said the company expects to limit operating expense growth to half the growth rate of revenue in 2026 and anticipates a lower operating loss. Management also said it expects to reduce cash burn by roughly half in 2026 compared with 2025, driven by higher revenue and gross margin, partially offset by investments in R&D, sales and marketing, and interest expense on debt. Gudonis added that, given uncertainty around Medicare Advantage payer behavior and the company’s go-to-market transition, management is taking a conservative posture and guiding to approximately 10% revenue growth with improvement in adjusted EBITDA.
About Myomo (NYSEAMERICAN:MYO)
Myomo, Inc (NYSE American: MYO) is a medical robotics company specializing in developing and commercializing powered orthotic devices designed to restore mobility and function for individuals with upper-limb weakness. The company’s flagship product, the MyoPro®, is an FDA-cleared, wearable robotic orthosis that leverages proprietary sensors and actuators to detect and amplify users’ own muscle signals, enabling patients with conditions such as stroke, spinal cord injury, muscular dystrophy and other neuromuscular disorders to perform daily activities with greater independence.
Myomo markets the MyoPro through a network of licensed orthotic and prosthetic professionals, clinics and hospitals across North America.
