Q3 2025 Neuronetics Inc Earnings Call
Good day and thank you for standing by. Welcome to the neuronetics, third quarter, 2025 earnings conference call. At this time, all participants are in a listen-only mode.
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I would now like to hand the conference over to your first Speaker today. Mark klausner investor relations, please go ahead
Good morning, and thank you for joining us for the neuronetics. Third quarter, 2025 conference call
Joining me on today's call are neuronetics president and chief executive officer, Keith Sullivan and Steve fansteel. Neuromatics Chief Financial Officer
Before I begin, I would like to caution listeners that certain information discussed by management. During this conference call will include forward-looking statements covered under the Safe Harbor, provisions of the private Securities. Litigation Reform, Act of 1995, including statements related to our business strategy, financial and revenue Guidance. The Greenbrook integration and other operational issues and metrics.
Actual results can differ materially from those stated or implied by these forward-looking statements due to risks and uncertainties associated with the company's business.
For a discussion of risks and uncertainties associated with the neuronetics business. I encourage you to review the company's filings with the Securities and Exchange Commission, including the company's quarterly report on form 10q, which was filed pre-market today.
The company, disclaims, any obligation to update, any forward-looking statements made during the course of this call. Except as required, by law.
During the call, we'll also discuss certain information on a non-gaap basis including even Dot.
Management believes that non-gaap financial information. Taken in conjunction with us gaap Financial, measures provide useful information for both management and investors by excluding certain non-cash and other expenses that are not indicative of Trends in our operating results.
Management uses non-gaap Financial measures to compare our performance relative to forecasts and strategic plans, to Benchmark, our performance externally against competitors. And for certain compensation decisions,
Reconciliations between us gaap and non-gaap results are presented in the table of the company. In our press release which can be viewed on our website with that. It's my pleasure to turn the call over to neuronetics president and chief executive officer Keith Sullivan.
Thanks Mark.
Good morning, and thank you for joining us today, I'll begin by providing an overview of the third quarter, performance and key operational updates. Steve fansteel will then review our financial results and I will conclude with some comments before turning to Q&A.
In the third quarter, we built real momentum as we worked through the integration and optimization of our combined operations.
We are finding opportunities to improve efficiencies, take advantage of our scale and streamline operations to capture the full value of the combined businesses.
Our recently announced partnership with Elite DNA is a great example of this which I'll provide more details on later in the call.
Total revenue was 37.3 million up, 11% on a proforma basis compared to Prior year quarter.
This growth was primarily driven by strong performance at our Greenberg clinics, which generated 21.8 million in Revenue up 25% on an adjusted proforma basis. Compared to the prior year quarter
Our integration efforts are delivering High treatment volumes across the neurostar TMS and spado patients.
Within the neurostar business, we had a solid quarter for system sales with 40 system shipped, an average selling price above our Target for the third quarter in a row.
That tells us customers, see real value in our technology and support importantly total neurostar treatment session utilization in the third quarter grew, 11% versus the prior year on a pro-forma basis.
Beyond our Revenue performance. We made significant strides on our path to cash flow positivity.
That progress comes from careful expense management and better cash collections.
Now turning to an update on our achievements during the third quarter.
Delivered strong results and continues to be a significant opportunity moving forward.
Contributing to the growth is our regional account manager or Ram program.
The optimization of the Rams continues to produce results as part of the initiative to build awareness among referring Physicians. We executed a targeted Outreach campaign during the third quarter. We quickly scheduled over 350 physician meetings for our Ram team. Most of which took place in the third quarter with the remainder in the fourth quarter.
These educational sessions are already building awareness and driving results.
To build on this momentum, we have dedicated 2, full-time intake, team members to this effort.
Equipping them with educational materials, that will make it simple for the Physicians to refer patients to Greenbrook clinics.
We have also seen notable enhancement in patient conversion rates through the coordination of automated patient transfer process.
QR codes and the Greenbrook intake team.
This process engages patients. While they are still at the referring Physicians office, which significantly increases the likelihood that they will follow through with the treatment in a Greenbrook clinic in the third quarter alone. Patients referred through the Rams totaled more than 2,200
our spado roll out remains on track with 84 of the 89, spado eligible clinics now, offering the therapy and we are on Pace for a full roll out by year end.
As we scale the program, we learned a lot about the economics of billing methods of buy and Bill versus administer and observe across our Network.
mainly that reimbursement varies by contract by state, and by Clinic,
Based on these insights, we have expanded by and Bill where the economics are favorable.
And this quarter, we added this billing method in Connecticut. Texas, Missouri, California and Virginia.
We can now use the best model for each patient and location, allowing us to drive increased sequential Privado treatment session, volume, while delivering stronger margins.
Turning to our second focused area. Our better me provider program.
This remains a key growth driver. We now have nearly 425 active BMP sites with another 100 sites working towards qualification.
The numbers prove this works BMP, sites respond to patients faster and are more knowledgeable about neurostar, TMS resulting in them. Treating significantly more patients per quarter than the non BMP practices.
Our neurostar provider connection program keeps building momentum.
As I mentioned last quarter, this program takes what is working at Greenbrooke and applies it to our NeuroStar customers.
through this initiative, our practice development managers are building awareness of neurostar TMS within Primary Care settings where 69% of patients with depression are currently being treated
since we launched this program in April,
We have hosted over 300, primary care, physician meetings, educating, approximately 3,000 providers on neurostar TMS and the results it can deliver for their patients.
The impact has been significant.
Many of these doctors did not know about neurostar TMS and are now excited to have a new option for patients, who have not responded to anti-depressants
We do not just educate them about neurostar, TMS we help connect them with the neurostar provider in their area.
Many of the primary care physicians, we talked to prefer to send patients to the BMP sites because of their commitment to patient responsiveness and education.
The feedback I have heard from our customers validates this approach.
For example. Dr. Ken Pages, who operates a private practice in Tampa. Florida told us that the neurostar provider connection program has been the most valuable resource. We have offered to help grow his practice.
To share information about neurostar TMS has been a home run for his business.
Dr. Paige is noted that for providers who have never heard of neurostar TMS. It is a great introduction. And for those who have referred to him in the past, it serves as a helpful, reminder to keep their treatment. Option in mind for patients, who could benefit from it,
In addition to our outbound cold calling team. We have also launched a directive provider ad campaign that is generated significant interest from pcps who have requested a meeting with our local neurostar, practice development manager.
Now, turning to our third strategic priority,
Operational excellence and cache optimization we made real progress here. This quarter since closing the Greenbrook acquisition, we have been improving efficiency across the network and several initiatives are driving results.
For example, our self-check-in kiosks,
as of mid November, the kiosks are live in over 30 centers.
More locations are coming online each week and we are on track for a full Network rollout by mid November.
Adoption has been exceptional.
Nearly every patient uses, the kiosk for check-in and payment.
The impact was immediate sites. Saw an increase in collection in the first week after installation.
We have integrated the kiosks with our EMR system, so paperwork gets completed right on the key kiosk.
Check-in is faster front desk, bottlenecks are reduced and this enables our staff to focus more on Direct patient care.
The feedback has been positive these tools. Let our technicians and intake coordinators to care. For more patients daily without adding headcount.
We also plan to leverage Ai and digital forms. In the intake process, these tools will reduce the traditional 45-minute consultation call by enabling patients to enter personal health information on their own time from home, reducing the friction and improving the patient experience while freeing up resources.
While technology is enabling efficiency, we are also taking a hard, look at our organizational structure.
Last quarter, I mentioned that we had brought in a consultant to review operations across the Greenbrook Network that review found opportunities to eliminate overlapping responsibilities and reduce management layers. Many of these changes are being implemented. For example, we have moved staff from our intake team to our provider connection group to support growth initiatives without additional headcount.
We have identified several other opportunities that will be implemented in the fourth quarter.
Revenue. Cycle management has been a major priority and we are seeing real gains. We have accelerated collection timing compared to earlier quarters. We are also shifting more patient payments to time of service through the kiosk which speed up cash collections. For the first time, we collected more cash in the quarter than we booked as Revenue in the quarter, that is real proof that the improvements we have made are working.
While we have made progress, we are not done.
The entire executive team is dedicated to further improvements.
Beyond these 3 priorities. We also focused on expanding treatment access and advancing our clinical evidence, we recently submitted a filing to the FDA which would broaden the eligible patient population.
I am also pleased to share that as of October, 1st New York State Medicaid began covering neurostar, TMS therapy for adults with major depressive disorder expanding access to over 5 million members Statewide
together these Regulatory and reimbursement, advancements show, Growing recognition of neurostar, TMS as an effective treatment option and reflect our commitment to making sure patients who need neurostar therapy can access it
to wrap up.
Our third quarter results demonstrate solid execution across our priorities.
Cash flow positivity.
I am confident in our team's ability to execute in the and in the value we are creating for both patients and shareholders.
I'd like to turn the call over to our CFO Steve fansteel.
For a financial update.
Thanks, Keith and good morning everyone. Unless otherwise noted all performance comparisons are being made for the third quarter of 2025 versus the third quarter of 2024.
total revenue in the third quarter of 2025 was 37.3 million, an increase of 101%, compared to the revenue of 18.5 million in the third quarter of 2024
the increase is primarily driven by the inclusion of Greenbrook operations, following our acquisition in December 2024,
On an adjusted ProForm of the basis which includes adjusting for both the impact of the Greenbrook acquisition and site closures, third quarter Revenue in 2025 increased by 11% versus the prior year.
total revenue from our neurostar business which includes our system Revenue as well as our treatment session Revenue was 15.5 million in the third quarter of 2025
On a pro forma basis, taking into account the impact of the intra-company revenue, this represents a decrease of 4% versus the prior year.
The change was primarily driven by the previously announced realignment of our Capital team to focus on strategic higher, growth accounts and a change in customer purchasing patterns for treatment sessions in 2025 versus 2024.
Us neurostar system Revenue was 3.5 million in the third quarter of 2025 and included shipment of a total of 40 systems.
The third quarter, also represented our third consecutive quarter of system, ASP greater than our Target demonstrating, the value of our system, and its features.
Us tremend session revenue was $10.5 million in the third quarter of 2025.
As Keith mentioned third, quarter neurostar, treatment session, utilization increased, 11% versus the prior year and treatment session purchases in the third quarter were closely aligned with utilization.
The decrease in third quarter treatment session Revenue versus the prior year is largely due to the impact of a change. In customer purchasing patterns, which led to increase customer inventory levels during 2024
us Clinic Revenue was 21.8 million for the 3 months. Ended September 30th 2025 a 25% adjusted proforma increase driven by growth and treatment sessions across both neurostar TMS and Privado patients.
Travado volumes were up sequentially in the third quarter versus the second quarter. While we also shifted to a higher percentage of administer and observe compared to buy and Bill.
This reflects our strategy of optimizing, our spread offering to drive the strongest profitability, which we evaluate on a by state payer in clinic basis.
Gross margin was 45.9%. Compared to 75.6% in the prior year quarter.
This change in gross margin was primarily a result of the inclusion of Green books Clinic business, which operates at a lower margin.
Operating expenses during the quarter were 24.44 million and increase of 2.7 million or 12%, compared to 21.7% of 2024.
The increase was primarily attributable to the inclusion of Greenbrook.
During the quarter, we incurred approximately 1.4 million of non-cash, stock-based compensation expense.
Net loss for the quarter was 9.4 million or 13 cents per share as compared to a net loss of 13.3 million or 444 cents per share in the prior year quarter.
Third quarter 2025 iida was -6.4 Million as compared to -11.6 million in the prior year.
Turning to the balance sheet as of September 30th, 2025 total. Cash was 34.5 million. Consisting of cash and cash, equivalents of 28 million and restricted cash of 6.5 million.
as previously communicated in our August earnings call, we became eligible and received an additional 10 million of funding under our existing debt agreement with perceptive, advisors
We became eligible for those funds as a result of achieving required Revenue conditions under the tranche 2 Funds.
We remain eligible for an additional 5 million of funds under the tranche 2 Funds. Additionally, within the third quarter, a total of 2.3 million shares were sold to the companies at the market facility, contributing net proceeds of 8 million.
The addition of these funds, strengthens our cash position providing us with strategic Financial, flexibility for the future.
Turning to cash flow. I am very pleased with our progress, this quarter, our cash use and operations. For the third quarter was 0.8 million which represents our second consecutive quarter of substantial Improvement.
to put this in perspective, our operating cash burn has decreased from 17 million in q1 to 3.5 million in Q2 and now just 0.8 million in Q3
This steady sequential Improvement. Validates the operational initiatives. We have implemented.
Cycle management improvements our accelerating the timing of current collections, as well as ensuring collection of longer aged receivables.
Additionally, expense discipline is paying off and operational efficiencies across. Greenbrook and neuronetics are taking hold.
Now turning to guidance.
for the fourth quarter, we expect net revenue of between 40 million to 43 million,
For the full year 2025. We now expect total revenue of between 147 and 150 million compared to previous guidance of 149 million and 1555 million.
The changing guidance is primarily driven by our expectations around SPIV buy and Bill usage. As we have learned more about the state and payer reimbursement dynamics, we have adjusted our spread offering to include the buy and Bill option only where reimbursement makes financial sense to do so.
For gross margin. We, now expect our full year to be between 47% and 49% versus our prior guidance of approximately 48% to 50%.
The changes driven by a shift in the overall mix of the business.
We continue to project operating expenses of between 100 and 105 million for the full year.
We continue to Target positive cash flow from operations in the fourth quarter of 2025 with a projected range of between 2 million of positive and 2 million of negative operating cash flow.
We further project year-end 2025 total cash, consisting of cash, cash equivalents, and restricted cash, to be in the range of $32 million to $36 million.
I will now turn it back to Keith for his closing remarks.
Thank you, Steve. Looking ahead. We are focused on driving growth across the business while being smart stewards of capital and cash collections.
Before I end, I want to highlight 2 exciting near-term opportunities within the neurostar business.
As outlined in last year's Q3 earnings call 1 of the key benefits of the Greenbrook. Transaction is that our scale allows us to provide broader service offerings to all of our customers.
By leveraging our Central intake center operation, we can help manage patient calls and education, more efficiently, potentially increase in conversion rates. And reducing the administrative burden required to meet the demands of neurostar TMS
Late in the third quarter. We finalized a 3 year agreement to be the Sole Provider of TMS systems within Elite DNA Behavioral Health.
1 of the Florida's, largest and fastest growing mental health networks, which has over 30 clinics.
as part of this agreement,
through a new wholly owned subsidiary, we will utilize the intake Center to Pilot a fee for service offering to Elite DNA which would include processing patient. Phq 10 responses as well as conducting and scheduling consultations and pre-assessments
In another important partnership, we deepened our relationship with Transformations Care Network which operates 72 clinics in the northeastern United States.
Through our service offerings, we can accelerate time to treatment for patients by leveraging. The Greenbrook intake centers expertise in performing benefits investigations.
These Partnerships will expand neuro star's footprint and will bring Advanced neurostar TMS access to thousands of patients through a scalable
systemize model of care.
Before we open up the call for questions, I would like to comment on the announcement today that I intend to retire from neuronetics on June 30th 2026. I'm extremely proud of what we have accomplished in the 5 plus years with the company. These accomplishments include the acquisition of Greenbrook TMS which is vertically, integrated, the company's value chain.
And the advancements of the neurostar, TMS technology.
And the millions of treatments we have performed that have saved. So many lives, our performance in the third quarter combined with the strength of our balance sheet has us entering the fourth quarter and 2026 with tremendous momentum and has the company well, positioned for long-term growth.
I am confident in the company's ability to execute on our priorities and create meaningful value for both our patients and our shareholders.
I look forward to participating in the search for my successor and to working closely with the new CEO once on board to ensure a seamless transition
With that, I'd like to turn the call over to the operator for questions.
Telephone and wait for your name to be announced.
To withdraw your question. Please press star 1 1 again.
Please stand by. We will compile the Q&A roster.
Our first question comes from the line of William Flynn of canaccord genuity. Your line is now open
Okay, great. Thanks. Uh, good morning and thanks for taking my questions. Um, just to kick it off, I was wondering, you know, definitely you're seeing solid growth on Proform in the Green Book site and maybe less so in the former Neurostar sites. I'm just kind of curious what's really driving those dynamics?
Certainly, um, you know, we we've, um, given out kind of our Clinic activity and looking at that quarter of a quarter, um, you can see that's up nearly 28% year-over-year. Um, I think that is leaning into, um, spread, um, inclusive of, of the vineville offering, although we're being very smart about how we optimize that. Um, but also, we continue to see growth on the TMS segment as well. So I think in general, you know, we've got the right clinics, um, to be driving that growth, we're very focused. Um, having a nice, uh, you know, extra growth driver in spread, especially with BNB, um, but we just see kind of continuing strong growth in in Greenbrook, um, driving along on the neurostar side of the business. I think, you know, the, the, the big thing to remember is, um, you know, we, we look at
I pay what are the actual treatment utilization? So how many times am our systems being used year over year? Um you know what we're saying is that's, you know, more than double-digit year-over-year compared to Q3 a year ago. I think the change in why we're not seeing that, that happen. Um, you know, translate to revenue growth. Um, is that this year? We're seeing those treatment session usage match, the purchases. Um, that makes sense. It means our customers are keeping up pretty steady level of treatment session inventory. This is different from 2024 where we saw customers strategically increase in inventory levels. Some of that was their own purchasing processes. There were some marketing other incentives, um, that drove a little bit of that. But particularly in Q3 of last year, um, we were still dealing with the impact of the change, Healthcare cyber events, which caused a lot of our customers to shift orders from Q2 into Q3. So in fact, while we're up utilization 11% year-over-year, that's more than offset by the fact that our customers in Q3 of last year, bought 13% more than they utilized.
In Q3. So that's 11 days. They increased inventory just in Q3 of last year. So that headwind is really kind of what's driving. I would say the, the lack of translation of that utilization increase to the revenue side. I think the positive note is for us, as we enter 2026, we expect it will be with normalized inventory levels and we wouldn't expect this kind of uh, uh headwind um, to reoccur as we get into 26. We'll have normal kind of comparison compared to periods
All right. Perfect. Okay. And then just down to the gross margin dynamics. You know, it's really been different—the reality or the outcomes versus what the expectations were at the time of the Greenbrook merger. And I'm just trying to figure out kind of what changed that was different than expected and are there any one-time headwinds kind of hitting things today? How should we think about this?
The the general, um, comment there. Um when I look at the margin I I really do it is you know we're kind of a mix of of kind of a higher margin and a lower margin business. Um if you look at the neurostar margins prior to the acquisition to look Q3 year to date, um you'd see that our GP margin was just under 75%, right? In that mid mid, mid 70% range that cost structure for the nearest. Our business largely Remains the Same today. There's there's been, you know, no significant change there. So really what's happened is we've mixed in this, you know, Greenbrook acquisition with the clinic business. Um, we know that operating at a lower margin so the the the big piece in my mind is okay, as you bring these together, it's, it's understanding that Revenue mix. Um,
Q2 that didn't repeat in Q3, and you just excluded that that kind of um, episodic uh, Compass Revenue, um, that would account for, you know, 60 of the 70 basis point change. We saw between Q2 and Q3 I, if I, if I think long term, what I'm uh probably most excited about on the Green Brook side is, um, we see the opportunity to optimize um, spread, um, making sure we stick with a&o where, that makes Financial sense and then expanding, uh, B&B where the reimbursement allows us to do that with the volume. We're seeing uh, we have some pretty significant leverage um, that we'll see in the 95 clinics and that is our Focus. Getting those 95 clinics as efficient as possible, where we'll be able to leverage provider fees, which are a big part of that cost of goods. But also, we're leaning into some of the Automation and other things that I think are going to help us continue to drive high patient growth um and and high treatments treatments. Um, but also do that very cost-effectively where we're not having to add costs and in some cases hopefully reduce costs
Um and then lastly, you know, is I think about some of the operational efficiencies you announced that you're finding even a year later. After the deal, I was wondering if you can quantify that for us is this another 2 million, another 5 million in cost savings. Because I mean you're so close to that cash flow positive. I mean that's it's a pretty um important uh cost savings. So I'm just trying to wonder if you could quantify that for us and then
And thanks for taking my questions and, and Keith, I know, you'll be around a couple more quarters. So I'm not saying goodbye yet.
Thanks Bill.
yeah, bill um, I don't think we've uh,
The total full impact that we can have, um, we are, uh, leaning into, like I said, on a few places where we have, uh, we know automation is going to help us. Um, I think the challenge here in the short term, maybe the next quarter or two, is there are some places where I think investment is going to make sense short term, that's going to drive long term. Um, the efficiency here,
so,
The clinic kiosk are 1. We've talked about that was, you know, cost to implement in Q3 and Q4, uh, but that's going to make us more efficient from a scheduling collection standpoint. Um, there's also additional automation, we can do, um, we've just started leaning into patient text alerts. I know that's been around for a little while, but we're adding that, um, into our Arsenal as well. So there's going to be investments in, in, in Q4 and probably even into q1. Um, but I think we'll we'll offset some of those gains obviously. We guided, uh, kept the guidance, the same on Opex, uh, but I do view it. As long term, there's still a significant opportunity for cost reduction and I think we'll provide more detail on that as we get towards next year.
Great. Thanks for taking my questions.
Thank you.
Our next question comes from the line of Adam mater of Piper Sandler. Your line is now, open.
Hi guys, this is Kyle winbourne on for Adam, thanks for taking the questions.
Maybe just to pry a little bit more on the treatment session Revenue, um, in the quarter, you know, even when you add back kind of the 2.2 million, that was attributable to Greenbrook. It was still down year-over-year and, um, I understand some of the commentary there. Maybe it's a little bit of a comps issue. Year-over-year with the inventory Dynamic, just curious, maybe like what gives you confidence going forward, you know that there's enough resources to kind of Drive success in both this business and the green book business just kind of to alleviate any worries that like there's a little bit of cannibalization going on there. Um, just any additional color would be would be helpful kind of as we think about the treatment session business going forward.
Yeah, absolutely. Um I think that the key piece and and we've added um 2 slides to our investor presentation deck um towards that towards the back. Um but we are showing kind of poorly Trends on utilization for the neurostar system. And I mentioned that earlier, I that's the key to me are our systems being used more and more for specific treatment sessions, that utilization piece. The fact that we see it at around 11% year-over-year and, you know, we expect to continue to see that type of growth that, that gives me.
Um you know take cost out uh but continue to drive Topline growth.
Uh, this is Keith. I also think a good indicator for us is what we're seeing on both the, uh, the ram referral side and the uh, provider connection. Both of those are gaining traction within the, uh, Primary Care Network. And we are seeing a large number of providers, who are interested in sending their patients to either a Greenbrook Clinic through the ram program or through provider connections. So, um, I, you know, I think
You know, we have seen that when a provider refers a patient in, they show up at a much higher rate than a patient that we get off of our marketing. So it's very encouraging to see the adoption on both sides.
Super helpful color. Thank you both. Um, and then maybe I guess last 1 for me, I, I'm Guidance the 40 to 43 million for Q4. I was curious if you could kind of just unpack the different businesses there. Uh, just since this was a little bit below where we were and where the street was for Q4 just would be helpful to kind of hear how you're thinking about the business trends for these different businesses, um, you know, looking out to your end.
Thanks. Yeah yeah. Happy to share a little bit more color. Obviously we added a 40 to 43 for the fourth quarter which uh translates to 147 to 150 for the full year. I I just really reflects, I think, uh, just a couple of items. The the biggest piece is really the impact of the spread Auto mix between a and O and B and B. Um we continue to see strong total spread Auto growth. Um but that mix between a and o and and B and B is something we have to monitor um in in the third quarter. Um AO representative about 86% of our SPV volume. Um that was up um
300 basis points, um, from where we were in Q2. Um, so obviously in that, that's a big revenue driver. In fact, if we had held our percentage of AO plaque from Q2 to Q3, our Q3 revenue would have been $38 million. Um, so that's about a three-quarter of a million impact of shifting to a higher amount of ano. We know ano provides less revenue, um, on a per patient basis. Um, but with AIO, we don't have to cover the cost of the drugs or handling the drug inventory. Um, and as we've said, there's just, uh, times where B&B just doesn't make financial sense. We don't get the right margin return, so this 140 to 7, uh, to 150, um, really reflects that shift of strategy to make sure we optimize that DNB offering. Um, that's something we spend a lot of time on.
Last quarter as Keith mentioned, the additional uh geographies that we're going to launch BNB here. Just starting to launch in Q4, we wanted to be very deliberate um and take our time on that I was actually proud in Q3 of how quickly we were able to to uh pivot and shift the percentage of an Ohio, you know, moving in those regions, where we just weren't getting the right return on B&B. We moved that very quickly, much much more quickly than actually, I would have thought. Um, so our updated guidance is really I think, primarily driven by this, um, Assumption of how
The AO and B&B, um, mix, um, evolving for the spread of business. Other than that, I I, I don't think there's a lot of impact for what we've been seeing on the neurostar side of the business Q4 is generally a, a good. Um,
Growth driver, on the neuro store, side of the business. We do have a little bit of of summer seasonality, as you as you look at, uh, the month of July and into August. Um, but there's also some positive capital seasonality
Things lined up or people to do heavier purchases at year end. So, um, that hopefully that gives you a little color on the trends as we think about the fourth quarter,
Yeah, that's all really helpful. Thanks guys.
Thank you.
Our next question comes from the line of Daniel stouter of citizens. Your line is now open.
Yeah. Hi great. Thanks for the questions. Um, first question I have is just on operating expense
You know, it looks like you're making good progress on the GNA line. Uh, but I wanted to ask how we should be thinking about the sales and marketing spend, uh, both as we contemplate fourth quarter and 2026. So you know, from our understanding, the provider connection program should be more efficient use of your marketing dollar. But just wanted to ask in your broader, thoughts on, on this spend and any strategy you have, uh, going forward.
Earlier is there's places where we're going to make, um, Investments, um, in in, in patients alert. Uh, the patient alerts other Technologies, um, we're doing some, I think some great things, um, doing more targeted marketing, um, in several regions, um, for the the Green Brook side of the business that I think. Um,
Pay off. So, you know, for me it's really a balance of um
Key investments that we want to make are going to drive long-term efficiency, but also, uh, things that are going to drive long term.
Growth. So I, I think as we get into 26, like I said, we'll give a little more color on, um, some of the other efficiencies and cost reductions in where we see Opex heading. But, you know, I, my commitment here is to make sure that, um, we have great cost control. We're investing where it makes complete sense. Um, but we still know that there are a ton of, um, opportunities here for efficiencies uh via cost reduction. Um, I just want to be really smart about how we evolve and make sure we
The right investments in place. So as we're reducing costs, we are not sacrificing Topline.
Okay, thanks, appreciate that. Um and just want to follow up for me.
Uh, wanted to ask on the Adolescent indication.
I think last quarter you mentioned, you saw an uptick in in patient starts here and saw some pretty good Trends, uh, but I don't think you gave too much color on it today. So I was just curious on what you're seeing there in the third quarter and what we should expect in.
Uh the rest of 25 minutes to 26 and also wanted to ask, you know, with this indication. Mine are you seeing more of a benefit from the provider connection program for these patients? Thanks.
Thanks Danny. Uh, this is Keith. So, uh, on the Adolescent front, we are seeing an uptick every single quarter. Um, and a lot of it is starting to come from the provider connection, uh, Network where these, uh, primary care physicians really had no idea that there was another alternative for, uh, their younger patients with depression. So, uh, I I don't think we're breaking out exactly how many patients, uh, that is. But it is it is uh, good growth with it. We also mentioned on the call that we have a another submission into the FDA that I think will also be meaningful uh as soon as we hear back from them. So
okay, great. Thanks for the call.
Thank you.
This concludes the question and answer session. I would now like to turn it back to Keith Sullivan for closing remarks.
Thank you for your interest in Neuronetics, and we look forward to updating you in the next quarterly call. Thank you.
All right, thank you for your participation. In today's conference, this does conclude the program. You may now disconnect