Full Year 2025 MDxHealth SA Earnings Call

February 26, 2026

Speaker #3: Good day and welcome to the MDxHealth fourth quarter and full year 2025 Earnings Conference call . All participants will be in listen only mode .

Operator: Good day. Welcome to the MDxHealth Q4 and full year 2025 earnings conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by 0. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press Star, then 1 on a touchtone phone. To withdraw your question, please press Star then 2. Please note that this event is being recorded. I would now like to turn the conference over to John Fraunces with LifeSci Advisors. Please go ahead.

Operator: Good day. Welcome to the MDxHealth Q4 and full year 2025 earnings conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star, then one on a touch-tone phone. To withdraw your question, please press Star then 2. Please note that this event is being recorded. I would now like to turn the conference over to John Fraunces with LifeSci Advisors. Please go ahead.

Speaker #3: Should you need assistance , please signal a conference specialist by pressing the star key , followed by zero . After today's presentation , there will be an opportunity to ask questions , to ask a question , you may press star , then one on a touch tone phone .

Speaker #3: To withdraw your question , please press star . Please note that this event is being recorded . I would now like to turn the conference over to John Francis with Lifesci advisors .

Speaker #3: Please go ahead

Speaker #4: Before we begin , I'd like to remind everyone that the company will make forward looking statements during today's call , whether in prepared remarks or during the Q&A session .

John Fraunces: Before we begin, I'd like to remind everyone that the company will make forward-looking statements during today's call. Whether in prepared remarks or during the Q&A session, these forward-looking statements are subject to inherent risks and uncertainties. These risks and uncertainties are detailed in the Risk Factors section of the company's filings with the Securities and Exchange Commission, specifically in the company's annual report on Form 20-F. I'll now turn the call over to Michael McGarrity, Chief Executive Officer.

Speaker #4: These forward looking statements are subject to inherent risks and uncertainties . These risks and uncertainties are detailed in the Risk Factors section of the company's filings with the Securities and Exchange Commission , specifically in the company's annual report on form 20 F .

Speaker #4: I'll now turn the call over to Michael McGarrity, Chief Executive Officer. Thanks, John.

Michael McGarrity: Thanks, John. Thank you all for joining us for our Q4 and full year 2025 earnings conference call for MDxHealth. With me today is Ron Kalfus, who has returned as our Interim Chief Financial Officer. We've been very consistent in our message and mission that MDxHealth is driven by 3 core operating principles: focus, execution, and growth. We believe that our strong results throughout 2025 demonstrate this commitment and that our guidance for 2026 will require that same commitment. We are very confident in our ability to deliver. Over the past few years, operating discipline, commercial execution, and an aggressive growth strategy has positioned MDxHealth as the leader in precision diagnostics focused in urology. It is important to note that our consistent performance and growth have been driven by the following foundational principles that are cemented in our mission.

Speaker #5: And thank you all for joining us for our fourth quarter and full year 2025 earnings conference call for MDxHealth With me today is Ron Kalfus , who has returned as our interim chief Financial officer We have been very consistent in our message and mission that MDxHealth is driven by three core operating principles focus , execution and growth We believe that our strong results throughout 2025 demonstrate this commitment , and that our guidance for 2026 will require that same commitment .

Speaker #5: We are very confident in our ability to deliver . Over the past few years , operating disciplined commercial execution and an aggressive growth strategy has positioned MDxHealth as the leader in precision diagnostics , focused in the urology .

Speaker #5: It is important to note that our consistent performance and growth have been driven by the following foundational principles that are cemented in our mission Menu .

Michael McGarrity: Menu expansion is driving a balanced growth dynamic across our tissue and liquid biopsy products. This strategy was a primary catalyst for the ExoDx acquisition, capitalizing on one of the largest market opportunities as it relates to patient need and total addressable market, which we believe now positions us with the best-in-class precision diagnostic menu across the patient pathway of prostate cancer. Prudent operating discipline, reflected in our reduced OpEx as a percentage of revenue over the past 3 years. Commercial execution and productivity, reflected in our consistent delivery of 20% top-line growth, while reducing sales and marketing spend as a percentage of revenue for the past 3 years.

Speaker #5: Expansion is driving a balanced growth dynamic across our tissue and liquid biopsy products . This strategy was a primary catalyst for the acquisition , capitalizing on one of the largest market opportunities as it relates to patient need and total addressable market , which we believe now positions us with the best in class precision diagnostic menu across the patient pathway of prostate cancer Prudent operating discipline reflected in our reduced OpEx as a percentage of revenue over the past three years Commercial execution and productivity reflected in our consistent delivery of 20% top line growth , while reducing sales and marketing spend as a percentage of revenue for the past three years Prudent execution of growth opportunities that stems from internal focused on not just where the market is today , but where it is headed , coupled with customer facing clinical needs , all of which resulted in acquisitions that have and will continue to fuel our growth .

Michael McGarrity: Prudent execution of growth opportunities that stems from internal focus on not just where the market is today, but where it is headed, coupled with customer-facing clinical needs, all of which resulted in acquisitions that have and will continue to fuel our growth and service to our patients and customers, as the core of our strategy beyond the financial leverage it has provided our business. Finally, an organizational commitment to the customer experience, reflected in our progress from candidly less than ideal turnaround time of critical tissue-based patient samples, to now a best-in-class, 5 days or less time to result, which is one of the highest customer experience metrics we track. We are incredibly proud of our entire organizational commitment to not only the financials, but what really matters to patients, staff, and clinicians.

Speaker #5: And service to our patients and customers . As the core of our strategy . Beyond the financial leverage that has provided our business .

Speaker #5: And finally , in organizational commitment to the customer experience reflected in our progress from candidly , less than ideal turnaround time of critical tissue based patient samples to now a best in class five days or less time to result , which is one of the highest customer experience metrics we track .

Speaker #5: We are incredibly proud of our entire organizational commitment to not only the financials , but what really matters to patients , staff and clinicians Taken together , these foundational principles are enabling MDxHealth to comprehensively address the needs of prostate cancer patients across the entire continuum of care .

Michael McGarrity: Taken together, these foundational principles are enabling MDxHealth to comprehensively address the needs of prostate cancer patients across the entire continuum of care. From an initial elevated PSA to and through each point along the diagnostic pathway of prostate cancer, MDxHealth can deliver a clinically actionable diagnostic for clinicians and patients. Finally, as it relates to our growth, we are confident that MDxHealth will continue to deliver market-leading growth, driven by focus and execution, coupled with a very sound and disciplined new product and acquisition strategy. As we go forward, we also expect to continue to achieve sustained top-line growth while advancing operating profitability. On a couple of final notes, in Q4, we began the integration of the ExoDx business and met our internal goal of transitioning all of our Select mdx customers to ExoDx, resulting in accelerated operating efficiencies, as we are no longer receiving Select mdx samples.

Speaker #5: From an initial elevated PSA two and through each point along the diagnostic pathway of prostate cancer , MDxHealth can deliver a clinically actionable diagnostic for clinicians and patients and finally , as it relates to our growth , we are confident that MDxHealth will continue to deliver market leading growth driven by focus and execution , coupled with a very sound and disciplined new product and acquisition strategy .

Speaker #5: As we go forward . We also expect to continue to achieve sustained top line growth while advancing operating profitability On a couple of final notes in Q4 .

Speaker #5: We began the integration of the business and met our internal goal of transitioning all of our select MDX customers to exo DX , resulting in accelerated operating efficiencies .

Speaker #5: As we are no longer receiving select MDX samples . We also initiated the integration of our strengthened sales organization with cross training and strategic mapping of the expanded customer base , which we expect to complete by the end of Q1 On a related note , our reported revenue of 107.9 million is $1 million less than the approximation we provided in our pre release at the time of our top line pre-release .

Michael McGarrity: We also initiated the integration of our strengthened sales organization with cross-training and strategic mapping of the expanded customer base, which we expect to complete by the end of Q1. On a related note, our reported revenue of $107.9 million is $1 million less than the approximation we provided in our pre-release. At the time of our top-line pre-release in advance of J.P. Morgan, our year-end closing process was less than complete than would typically be the case. With the recent acquisition of ExoDx, we have had to rationalize and consolidate disparate and quite complex closing processes, which directly impacts our methodology for calculation of ASPs and top-line revenue. However, the adjustment of $1 million to our pre-release revenue estimate does not affect our 2026 revenue guidance, nor the confidence in our growth trajectory.

Speaker #5: In advance of J.P. Morgan , our year end closing process was less than complete than would typically be the case with the release and acquisition of exo DX .

Speaker #5: We have had to rationalize and consolidate disparate and quite complex closing processes , which directly impacts our methodology for calculation of ASPs and top line revenue However , the adjustment of $1 million to our pre-release revenue estimate does not affect our 2026 revenue guidance , nor the confidence in our growth trajectory .

Speaker #5: As always , our revenue guidance is based solely on unit growth associated with customer adoption and is not dependent on accelerating pricing dynamics .

Michael McGarrity: As always, our revenue guidance is based solely on unit growth associated with customer adoption and is not dependent on accelerating pricing dynamics. We also announced our amendment to the Exact Sciences earn-out from the GPS acquisition, lowering our upcoming earn-out payment by close to $20 million, while deferring by an additional year the full earn-out amount. This provides MDxHealth with additional flexibility as we go forward with confidence of continued progress in our operating profitability profile, as reflected in our adjusted EBITDA performance, which we expect to reach 10% of revenue as we exit this year. I will follow up with closing comments and view forward. First, let me turn the call over to Ron Kalfus, whom we have welcomed back to the role of Interim Chief Financial Officer.

Speaker #5: We also announced our amendment to the Exact Sciences earnout from the GPS acquisition, lowering our upcoming earnout payment by close to $20 million.

Speaker #5: While deferring by an additional year . The full Earnout amount This provides MDxHealth with additional flexibility as we go forward with confidence of continued progress in our operating profitability profile as reflected in our adjusted EBITDA performance , which we expect to reach 10% of revenue as we exit this year .

Speaker #5: I will follow up with closing comments and view forward , but first , let me turn the call over to Ron Kalfus , whom we have welcomed back to the role of Interim Chief Financial Officer Ron has been a valued member of our team for the past six years of growth , and consistent financial results .

Michael McGarrity: Ron has been a valued member of our team for the past 6 years of growth and consistent financial results, coupled with his fiduciary duty to all of our stakeholders, which is of the highest quality and integrity. Welcome back, Ron.

Speaker #5: Coupled with his fiduciary duty to all of our stakeholders, which is of the highest quality and integrity. Welcome back, Ron.

Speaker #6: Thanks very much , Mike . To follow on Mike's remarks , we're very pleased to report strong performance in the fourth quarter and full year of 2025 .

Ron Kalfus: Thanks very much, Mike. To follow on Mike's remarks, we're very pleased to report strong performance in Q4 and full year of 2025. Q4 total billable volume was approximately 38,000 tests, of which approximately 11,000 were tissue-based and 27,000 were liquid-based tests, and representing total unit growth of 62% versus the prior year quarter. Volumes for our tissue-based tests, which include Confirm mdx and GPS, decreased by 5% over the prior year period. Volumes for our liquid-based tests, which include Select mdx, Resolve mdx, and the newly acquired ExoDx, increased by 128% over the prior year quarter. Revenues for Q4 ended 31 December 2025, increased by 19% to $29.5 million, versus $24.7 million for the prior year quarter.

Speaker #6: Q4 total billable volume was approximately 38,000 tests , of which approximately 11,000 were tissue based and 27,000 were liquid based . Tests and representing total unit growth of 62% versus the prior year quarter volumes .

Speaker #6: For our tissue based tests , which include confirmed MDX and GPS , decreased by 5% over the prior year period . Volumes for a liquid based test , which include select MDX , resolve , MDX , and the newly acquired exo DX , increased by 128% over the prior year quarter Revenues for the fourth quarter ended December 31st , 2025 increased by 19% to $29.5 million versus $24.7 million for the prior year quarter .

Speaker #6: Moving below the revenue line, gross profit for the quarter was $18.7 million, an increase of 20% as compared to $15.5 million for the fourth quarter of 2020.

Ron Kalfus: Moving below the revenue line, our gross profit for Q4 was $18.7 million, an increase of 20% as compared to $15.5 million for Q4 2024. Gross margins were 63.2%, compared to 62.7% for Q4 2024, an increase of 0.5 percentage points, primarily attributed to economies of scale. Our operating loss for Q4 increased 14% to $5.3 million, compared to $4.6 million for Q4 2024, primarily driven by increases in headcount and other operating expenses related to the ExoDx acquisition.

Speaker #6: For gross margins were 63.2% , compared to 62.7 for Q4 , 24 , an increase of 0.5 percentage points , primarily attributed to economies of scale .

Speaker #6: Our operating loss for the quarter increased 14% to $5.3 million , compared to $4.6 million for the fourth quarter of 2020 . For primarily driven by increases in headcount and other operating expenses related to the acquisition , our net loss increased 31% to $8.9 million , compared to $6.8 million for the prior year , driven by an increase of $3.1 million in net financial expenses , partially offset by a tax gain of $1.6 million .

Ron Kalfus: Our net loss increased 31% to $8.9 million, compared to $6.8 million for the prior year, driven by an increase of $3.1 million in net financial expenses, partially offset by a tax gain of $1.6 million. Adjusted EBITDA for Q4 was a negative $2.1 million, compared to a negative $1.4 million for Q4 of 2024. Note that our reconciliation of IFRS to non-IFRS financial measures has been provided in the tables included in this press release. Cash and cash equivalents as of 31 December 2025 were $29 million. This concludes my overview of the results. I will now turn the call back to Mike.

Speaker #6: Adjusted EBITDA for the fourth quarter was a -$2.1 million , compared to a -$1.4 million for the fourth quarter of 2020 . For note that our reconciliation of IFRS to IFRS financial measures has been provided in the tables included in this press release .

Speaker #6: Cash and cash equivalents . As of December 31st , 2025 were $29 million . This concludes my overview of the results . I'll now turn the call back to Mike .

Speaker #5: Thanks , Ron . We believe our Q4 results reflect the reputation we are building for excellence and focus execution and growth . And so as we look forward , we are committed to the .

Michael McGarrity: Thanks, Ron. We believe our Q4 results reflect the reputation we are building for excellence in focus, execution, and growth. As we look forward, we are committed to the following operating principles: Discipline in our capital allocation, as reflected in our negotiated amendment with Exact Sciences, which we believe reflects their confidence with continued investment in our success. Absolute dedication to the patient and customer experience by every single part of our organization. The highest expectations for continued growth, driven by our sales channel to meet or exceed expectations defined by performance over time, with a culture of recognizing execution through an incentive compensation plan that rewards sustainable growth. Our culture of quality first and customers always will ensure our building reputation for excellence in operating discipline, commercial execution, and most importantly, the patient and customer experience, which will continue to fuel our growth in a sustainable way.

Speaker #5: Following operating principles . Discipline in our capital allocation as reflected in our negotiated amendment with exact Sciences , which we believe reflects their confidence with continued investment in our success Absolute dedication to the patient and customer experience by every single part of our organization The highest expectations for continued growth .

Speaker #5: Driven by our sales channel to meet or exceed expectations defined by performance over time with the culture of recognizing execution through an incentive compensation plan that rewards sustainable growth Our culture of quality first and customers always will ensure our building reputation for excellence in operating discipline , commercial execution and most importantly , the patient and customer experience which will continue to fuel our growth in a sustainable way It is important to note that with the acquisition , we have reorganized our revenue cycle management team under new leadership to drive best in class access , predictability and collection across our expanded menu of tests and payers .

Michael McGarrity: It is important to note that with the ExoDx acquisition, we have reorganized our revenue cycle management team under new leadership to drive best-in-class access, predictability, and collection across our expanded menu of tests and payers. Also supporting our payer efforts is our commitment to invest in advancing our robust clinical data to show improvements in both patient outcomes and healthcare economics. As final evidence of these efforts, I would point to our recently communicated progress on our landmark collaboration with the University of Oxford, with the completion of the GPS-ProMPT study, which we now expect to be presented at the upcoming EAU conference by our principal investigators from Oxford.

Speaker #5: Also supporting our payer efforts is our commitment to invest in advancing our robust clinical data to show improvements in both patient outcomes and health care economics As final output of these efforts , I would point to our recently communicated progress on our landmark collaboration with the University of Oxford .

Speaker #5: With the completion of the GPS prompt study , which we now expect to be presented at the upcoming EA conference by our principal investigators from Oxford Our Oxford collaboration now moves to commencement of the GPS protect study , evaluating the predictive power of GPS test in patients enrolled in the U.K.

Michael McGarrity: Our University of Oxford collaboration now moves to commencement of the GPS-ProtecT study, evaluating the predictive power of GPS test in patients enrolled in the UK ProtecT randomized trial of over 1,500 men with localized prostate cancer, followed for over two decades. As the largest trial ever conducted to evaluate such diagnostic assessment, the outcomes of this landmark study will position MDxHealth as the leader in risk stratification of newly diagnosed with localized prostate cancer. We also expect the trial will serve to advance the utility of GPS in the NCCN guidelines, which would uniquely position GPS as the test with the highest level of evidence in prostate cancer patients being considered for active surveillance. We are very proud of our growing reputation for meeting or exceeding expectations and delivering on our commitments to patients, customers, and the market.

Speaker #5: . Protect randomized trial of over 1500 men with localized prostate cancer , followed for over two decades . As the largest trial ever conducted to evaluate such diagnostic assessment , the outcomes of this landmark study will position MDxHealth as the leader in risk stratification of patients newly diagnosed with localized prostate cancer .

Speaker #5: We also expect the trial will serve to advance the utility GPS in the NCCN guidelines , which would uniquely position GPS as the test with the highest level of evidence in prostate cancer patients being considered for active surveillance .

Speaker #5: We are very proud of our growing reputation for meeting or exceeding expectations and delivering on our commitments to patients , customers and the market , whether in the sales force , laboratory operations , revenue cycle management , client services , patient advocacy , quality and regulatory , our entire MDX team operates under the mission that there is a patient and family on the other side of every sample .

Michael McGarrity: Whether in the sales force, laboratory operations, revenue cycle management, client services, patient advocacy, quality, and regulatory, our entire MDxHealth team operates under the mission that there is a patient and family on the other side of every sample we receive. That is what drives our customer base to trust MDxHealth as their laboratory partner for critical diagnostic tests that inform patient pathways. We will continue to strive to deliver on our commitments of growth and value while positioning MDxHealth as the leading growth precision diagnostics company, focused solely into our high-growth target urology market. As always, we carry a great deal of responsibility to provide value to all of our stakeholders, including patients, customers, payers, and shareholders. Thank you for your interest in and support of MDxHealth. Now I'll turn the call back over to the operator for questions.

Speaker #5: We receive . That is what drives our customer base to trust . MDxHealth as their laboratory partner for critical diagnostic tests that inform patient pathways .

Speaker #5: We will continue to strive to deliver on our commitments of growth and value , while positioning MDxHealth as the leading growth , precision diagnostics company focused solely into our high growth target .

Speaker #5: Urology market . And as always , we carry a great deal of responsibility to provide value to all of our stakeholders , including patients , customers , payers and shareholders .

Speaker #5: Thank you for your interest in and support of MDxHealth. Now I'll turn the call back over to the operator for questions.

Speaker #3: Thank you . We will now begin the question and answer session to ask a question . You may press star , then one on your touch tone phone .

Operator: Thank you. We will now begin the question-and-answer session. To ask a question, you may press star then one on your touchtone phone. If you are using a speakerphone, please pick up your handset before pressing the keys. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. At this time, we will pause momentarily to assemble our roster. Our first question today comes from Thomas Flaten with Lake Street Capital Markets. Please go ahead. Thomas, is your line muted? Hi, Thomas. Is your line open now? We can move on to the next question, coming from Bill Bonello with Craig-Hallum. Please go ahead, sir.

Speaker #3: If you're using a speakerphone , please pick up your handset before pressing the keys . If at any time your question has been addressed and you would like to withdraw your question , please press star then two .

Speaker #3: At this time, we will pause momentarily to assemble our roster. Our first question today comes from Thomas Flaten with Lake Street Capital Markets.

Speaker #3: Please go ahead, Thomas. Is your line muted? Hi Thomas, your line is open now. We can move on to the next question, coming from Bill Bonello with Craig-Hallum.

Speaker #3: Please go ahead sir

Speaker #7: Hey guys thanks a lot . Thomas's question to so a few questions . The the tissue ASP was down about 100 bucks quarter over quarter .

Bill Bonello: Hey, guys. Thanks a lot. I'll take Thomas's question, too. Few questions. The tissue ASP was down about $100, quarter-over-quarter. Should we think of that as continued mix shift towards confirm? Anything happening on, you know, rates of denials or anything like that?

Speaker #7: Should we think of that as continued mix shift towards confirm anything happening on you know , rates of denials or anything like that

Speaker #5: No . Bill , I think your assumption is correct . You know , again , as we report tissue , it's a combination of GPS and confirm .

Michael McGarrity: No, Bill, I think your assumption is correct. You know, again, as we report tissue, it's a combination of GPS and Confirm, and I think you're reading right on it, right? The ASPs, we tend to reflect them based on the Medicare rates, Confirm $2,000, GPS $3,850. If we have a 20% quarter, whatever the growth mix is, you know, a 2- or 3-point swing, it's been balanced as I've communicated. One isn't carrying the day on our growth. But a shift in a quarter of that mix can affect the ASP, assuming you're just taking units and dividing it by the total revenue.

Speaker #5: And I think you're reading right on it . Right . So the ASPs , we , we we tend to reflect them based on the Medicare rates confirmed 2000 GPS , 3850 .

Speaker #5: So if we have a 20% quarter or whatever the growth mix is , you know , a 2 or 3 point swing , it's been balanced as I've communicated .

Speaker #5: One is in carrying the day on our growth. But a shift in a quarter of that mix can affect ASP. Assuming you're just taking units and dividing it by the total revenue.

Speaker #7: Sure . Okay . And then the the the EBITDA and maybe this is sort of a two parter . And I'll stop the EBITDA was a little bit lower than we expected .

Bill Bonello: Sure. Okay. Then, the EBITDA, and maybe this is sort of a two-parter, and I'll stop. The EBITDA was a little bit lower than we expected, obviously, you know, down from where it's been running and down from last year. The cash flow use was, you know, a lot higher than where it has been. Can you just kinda talk about what's going on there and sort of your expectation? I know you expected it to be at 10% EBITDA margin as you're exiting the year, but maybe, you know, more particularly, just thoughts on cash burn going forward, need for financing, that kind of thing.

Speaker #7: Obviously , you know , down from where it's been running and down from last year . The cash flow use was , you know , a lot higher than than where it has been .

Speaker #7: Can you just kind of talk about what's going on there and sort of your expectation ? I know you expect it to be at 10% EBITDA margin as you're exiting the year .

Speaker #7: But but maybe , you know , more particularly just thoughts on cash burn going forward , need for financing , that kind of thing .

Speaker #5: Yeah . So a couple parts to that question , Bill . So let me comment . You know , as I've signaled , we expected some chop in Q4 and likely into Q1 as we absorb the acquisition of the Xodiac business , we expect that as is signal bear guidance to provide a significant growth opportunity both in 2026 and beyond .

Michael McGarrity: Yeah. A couple parts to that question, Bill, so let me comment. You know, as I've signaled, we expected some chop in Q4 and likely into Q1 as we absorb the acquisition of the ExoDx business. We expect that, as signaled by our guidance, to provide a significant growth opportunity both in 2026 and beyond. We don't view that as anything more than absorbing all that. This is our first full quarter with that acquisition coming into our operation. I think when you look at our P&L leverage, I would maybe point to kind of the last two years. If you look at 2024, you know, we grew top line 28%, we had negative $15 million in EBITDA, or negative 20% EBITDA margin.

Speaker #5: So we don't view that as anything more than absorbing all that . This is our first full quarter with with that acquisition coming into our operation , I think when you look at our pal leverage , I would maybe point to kind of the last two years , if you look at 2024 , you know , we grew top line 28% and our we had -15 million in EBITDA or -20% EBITDA margin this year on 20% growth .

Michael McGarrity: This year, on 20% growth, we had $1 million, it's essentially flat. As we come into this year, guiding to the midpoint, let's call it 28% growth, and exiting the year at a 10% EBITDA margin. You know, we view that as a 30 point EBITDA margin swing over the last 24 to 36 months. Full confidence in the ability of our business to absorb our top line or OpEx as a percentage of our top line growth is noted, right? They're all declining as a percentage of revenue.

Speaker #5: We had $1 million . So essentially flat . And as we come into this year , guiding to the midpoint , let's call it 28% growth and exiting the year at a 10% EBITDA margin .

Speaker #5: You know , we view that as a as a 30 point EBITDA margin swing over the last 24 to 36 months . So .

Speaker #5: Full confidence in the ability of our business to absorb our top line growth or opex as a percentage of our top line growth is noted right there .

Speaker #5: All declining as a percentage of revenue . But as we get the integration going in Q4 and into Q1 , that'll that'll clear .

Michael McGarrity: As we get the integration going in Q4 and into Q1, that'll clear, and we're very confident that swing. It all comes down to the absorption of our OpEx, based on that top line growth, which we're very confident in. We've been able to hold our, you know, core with apples to apples, all of our operating sales and marketing, G&A, and R&D, relatively flat over the past 3 years on 20% or greater growth. Hopefully that helps.

Speaker #5: And we're very confident that that swing and all comes down to the absorption of our opex based on that top line growth , which we're very , very confident in .

Speaker #5: We've been able to hold our , you know , core with apples to apples , all of our operating sales and marketing , G&A , R&D , relatively flat over the past three years on 20% or greater growth .

Speaker #5: So hopefully that helps . Yeah , that goes right to the right through to the cash use . Yeah . And then that coupled with the , you know , candidly , the relief on the earnout through our amendment very confident that quarter by quarter this year that that shows up and flows through our full PNL

Nelson Cox: Yes, that, it helps.

Bill Bonello: Yes, that, it helps.

Michael McGarrity: That goes right through to the cash use.

Nelson Cox: Yeah.

Bill Bonello: Yeah.

Michael McGarrity: That coupled with the, you know, candidly, the relief on the earn-out through our amendment, very confident that quarter by quarter this year, that shows up and flows through our full P&L.

Speaker #7: Thanks a lot .

Nelson Cox: Thanks a lot.

Bill Bonello: Thanks a lot.

Speaker #5: Thank you . Bill .

Michael McGarrity: Thank you, Bill.

Speaker #3: The next question comes from Andrew Brackman with William Blair . Please go ahead

Operator: The next question comes from Andrew Brackmann, with William Blair. Please go ahead.

Speaker #8: Hey , this is Kate Jansen on for Andrew . Thanks so much for taking the questions . Just on the guide , your 2026 revenue midpoint implies roughly 28% year over year growth , which is consistent with recent momentum .

Kate Jansen: Hey, this is Kate Jansen on for Andrew. Thanks so much for taking the question. Just on the guide, your 2026 revenue midpoint implies roughly 28% year-over-year growth, which is consistent with recent momentum. Can you walk us through the assumptions behind that guidance? Just specifically, how much is coming from core volume growth versus incremental contribution from ExoDx and cross-selling across the expanded menu, and just kind of the levers that get to the high and low end of that? Thanks.

Kate Jensen: Hey, this is Kate Jansen on for Andrew. Thanks so much for taking the question. Just on the guide, your 2026 revenue midpoint implies roughly 28% year-over-year growth, which is consistent with recent momentum. Can you walk us through the assumptions behind that guidance? Just specifically, how much is coming from core volume growth versus incremental contribution from ExoDx and cross-selling across the expanded menu, and just kind of the levers that get to the high and low end of that? Thanks.

Speaker #8: Can you walk us through the assumptions behind that guidance ? Just specifically , how much is coming from core volume growth versus incremental contribution from DX and cross-selling across the expanded menu ?

Speaker #8: And just kind of the levers that get to the high and low end of that . Thanks .

Speaker #5: Yeah . Okay . You know , I think that we we don't really guide to product or segment on the tissue and liquid side .

Michael McGarrity: Yeah, Kate, you know, I think that we don't really guide to product or segment on the tissue and liquid side. Clearly, we really had two goals with this acquisition, right? One was to solve for the challenge we had from the, in the market with Select. The second really was to drive balance in our growth profile with tissue and liquid, right? We had got to the point last year where tissue was carrying 85% of our revenue. We'd prefer to see that balanced. I had signaled that we expected $20 million or more contribution from ExoDx based on the acquisition in the full year of 2026.

Speaker #5: Clearly , our we we really had two goals with this acquisition , right . One was to solve for the challenge we had in the market with select .

Speaker #5: The second really was to drive balance in our growth profile with tissue and liquid . Right . We got to the point last year where tissue was carrying 85% of our revenue .

Speaker #5: We prefer to see that balance. And then I had signaled that we expected a $20 million or more contribution from XO based on the acquisition in the full year 2026.

Speaker #5: Now , as I noted , we we actually kind of exceeded our expectations of the conversion of select to XO in Q4 , which requires a significant focus from our sales and full commercial organization .

Michael McGarrity: Now, as I noted, we actually kind of exceeded our expectations of the conversion of Select to Exo in Q4, which requires a significant focus from our sales and full commercial organization. Hundreds of customers that we converted successfully. Into Q1, we'll continue with the integration of the sales organization from a cross-training and customer mapping perspective. A lot of the pieces of this acquisition, to your question, was the combined customer base of ExoDx and MDxHealth, and that's our real focus to capitalize on that. To meet or exceed our revenue guidance of $137 to 140 million this year, it will require, which we are very, very confident in, that balanced growth across both tissue and liquid, as well as an opportunistic capitalization of that combined customer base.

Speaker #5: Hundreds of customers that we converted to successfully in the Q1 . We'll continue with the integration of the sales organization from across training and customer mapping perspective .

Speaker #5: So, a lot of the thesis of this acquisition, to your question, was the combined customer base of XO and MDxHealth, and that's our real focus—to capitalize on that.

Speaker #5: So to meet or exceed our , our revenue guidance of 137 to $140 million this year , it will require which we are very , very confident in that balance growth across both tissue and liquid , as well as an opportunistic capitalization of that combined customer base .

Speaker #5: So that's probably what I can give you right now . But we're very confident that the conversion of the select to XO customers was a big step .

Michael McGarrity: That's probably what I can give you right now, but we're very confident that the conversion of the Select to Exo customers was a big step. The completion of the cross-training and integration here in Q1 of the newly structured sales organization, and then really driving the adoption of our full menu and our customer base is our goal.

Speaker #5: The completion of the cross training and integration here in Q1 of the newly structured sales organization and then really driving the adoption of our full menu and our customer base is our goal

Kate Jansen: That's great. Super helpful. I guess kind of just building off of that, now that you have transitioned all the customers to ExoDx and started strategically mapping that expanded customer base, after that's completed in Q1, can you provide any more detail on what you kind of expect to gain from those efforts? Thank you.

Speaker #8: That's great . Super helpful . And then I guess kind of just building off of that . Now that you have transitioned all the customers to XO and started strategically mapping out , expanded customer base after that's completed in Q1 , can you provide any more detail on what you kind of expect to gain from those efforts ?

Kate Jensen: That's great. Super helpful. I guess kind of just building off of that, now that you have transitioned all the customers to ExoDx and started strategically mapping that expanded customer base, after that's completed in Q1, can you provide any more detail on what you kind of expect to gain from those efforts? Thank you.

Speaker #8: Thank you

Speaker #5: Yeah . Kate , I think you know what we expect to gain is , is what I mean by the combined mapping of the customer base , right ?

Michael McGarrity: Yeah, Kate, I think, you know, what we expect to gain is what I mean by the combined mapping of the customer base, right, is the Exo customer base, and this was a key part of our diligence, right? Looking at their business, the challenge we had with Select, obviously, was the fundamental catalyst. As our diligence progressed, right, the quality of the sales reps that we took over from Exo was primary, but also a function of where their business was in relation to ours. You know, if we have a strong Exo DX customer that doesn't read right on our Confirmer GPS or vice versa, we view that as a key aspect of the leverage we can generate with the top-line growth. It's, you know, it's not a hope that that will happen.

Speaker #5: Is . The XO customer base . And this was a key part of our diligence , right ? Looking at their business , the challenge we have with select obviously was the fundamental catalyst .

Speaker #5: But then as our our diligence progressed , right . The quality of the sales reps that we took over from XO was primary , but also a function of where their business was in relation to ours .

Speaker #5: So if we have a strong XO customer that doesn't read right on our confirm , our GPS or vice versa , we view that as a key aspect of the leverage we can generate with the top line growth .

Speaker #5: But it's you know , it's not a hope that that will happen . Our guidance reflects clear visibility to that as well as continued execution as we've delivered .

Michael McGarrity: Our guidance reflects clear visibility to that, as well as continued execution as we've delivered, you know, over the past 3 or 4 years with that goal of 20% or greater growth. It's obviously accelerating this year with the Exo. Very confident that comes together, and we'll continue to work through Q1 to solidify that, and count on our continued discipline to absorb the acquired OpEx to get us to that 10% EBITDA margin.

Speaker #5: You know , over the past 3 or 4 years with that goal of 20% or greater growth , it's obviously accelerating this year with the XO , but very confident that comes together and we'll continue to work through Q1 to solidify that .

Speaker #5: And then count on our continued discipline to absorb the acquired OpEx to get us to that 10% EBITDA margin .

Speaker #8: Okay , great . Thanks for the color .

Operator: Okay, great. Thanks for the color.

Kate Jensen: Okay, great. Thanks for the color.

Speaker #5: Thanks , Kate .

Michael McGarrity: Thanks, Kate.

Speaker #3: The next question today comes from Nelson Cox with Lake Street Capital Markets. Please go ahead.

Operator: The next question today comes from Nelson Cox with Lake Street Capital Markets. Please go ahead.

Speaker #9: Yeah . Hey , thanks for taking the questions . Just kind of following up on the adjusted EBITDA margin , 10% exiting 2026 .

Nelson Cox: Yeah, hey, thanks for taking the questions. Just kind of following up on the adjusted EBITDA margin, 10% in 2026. You've held them up OpEx virtually flat through 2025 and growing the top line 20%. Can you kind of talk about in a little more detail where there's additional operating leverage left to come, where you can find additional operating leverage? Is there more you can take out in sales and marketing as a percentage of revenue, which I think was 39%, 2025? I mean, how much lower can that go? Then is kind of mid-60% gross margin still kind of the right baseline to have for now?

Speaker #9: You've held them up virtually flat through 2025 . And growing the top line 20% can kind of talk about a little more detail where there's additional leverage left to to come , where you can find additional operating leverage .

Speaker #9: Is there more you can take out in sales and marketing as a percentage of revenue , which I think was 39% , 20 , 25 .

Speaker #9: How much lower in that go ? And then it's kind of mid 60% gross margin . Still kind of the right baseline to have for now

Speaker #5: Yeah . So two part question there . The first part is , you know , we as we have this past year right going into this year we're very confident that we can hold our opex relatively fixed .

Michael McGarrity: Yeah. Two-part question there. The first part is, you know, as we have this past year, right? Going into this year, we're very confident that we can hold our OpEx relatively fixed, right? As part of the acquisition in Q4, the increase in OpEx was largely associated with the headcount across the organization that we took over, right? Sales, revenue, cycle management, client services, as well as our investment in our, you know, clinical scientific affairs efforts, as evidenced by the Oxford partnership, which we are very confident will return greatly as we go beyond this year and into the next 2 to 3 years. We don't expect to expand OpEx this year as we go forward.

Speaker #5: Right . We've we as part of the acquisition in Q4 , the increase in opex was largely associated with us . The headcount across the organization that we took over .

Speaker #5: Right . So sales revenue cycle management , services , as well as our investment in our , you know , clinical , scientific affairs efforts , as evidenced by the Oxford Partnership , which we are very confident will return greatly as we go beyond this year .

Speaker #5: And and into the 2 to 3 years . So there's really no we don't we don't expect to expand CapEx this year as we go forward

Speaker #9: Got it. And then maybe just quickly on that gross margin.

Nelson Cox: Got it. Maybe just quickly on that gross margin.

Speaker #5: Oh I'm sorry Nelson . Yeah , the gross margin . You know what I've stated on the gross margin is we've been bouncing around in the low 60s anywhere for the last number of quarters .

Michael McGarrity: Oh, I'm sorry, Nelson. Yeah, the gross margin, you know, what I've stated on the gross margin is we've been bouncing around in the low sixties anywhere for the last number of quarters. That's where we expected to be and where we needed to be, candidly, to get to EBITDA profitability pre the Exo acquisition. We guided to that in the beginning of 2024, that we would turn in the middle of 2025, which we did, which I think I would just say speaks to the predictability of our operating discipline and our top line growth. You know, I think we expect that to continue to range there. It's really a function of our expanded menu, right?

Speaker #5: That's where we expected to be and where we needed to be , candidly , to get to EBITDA profitability pre the acquisition . We guided to that in the beginning of 2024 that we would turn in the middle of 2025 , which we did , which I think I would just say speaks to the predictability of our operating discipline and our top line growth .

Speaker #5: So , you know , I think we expect that to continue to range there . It's really a function of our expanded menu .

Speaker #5: Right . So each quarter we not only see different mix between our four products and our two segments . Tissue and liquid , but even within each of those products , each quarter can carry a different to Bill's question at the beginning , at different mix by payers that that leads to the 2 or 3 point swing by quarter .

Michael McGarrity: Each quarter, we not only see different mix between our four products and our two segments, tissue and liquid, but even within each of those products, each quarter can carry a different, to Bill's question, beginning a different mix by payers. That leads to the 2 or 3-point swing by quarter. Are we aspirational in our gross margin going into the high sixties or ultimately starting with the seven? We are, and I would say that we are turning our attention to the other side of that, which is our operating efficiency, which would obviously show up in COGS, as well as obviously driving price. That's given, we think we have some leverage there as well.

Speaker #5: But are we aspirational on our gross margin going into the high 60s or ultimately starting with the seven we are ? And I would say that we are turning our attention to the other side of that , which is our operating efficiency , which would obviously show up in Cogs as well as obviously driving price .

Speaker #5: That's given . But we think we have some leverage there as well . But for right margin we would expect to to run pretty straight away through this year and that would allow us to get to that 10% margin

Michael McGarrity: For right now, the margin, we would expect to run pretty straight away through this year, and that would allow us to get to that 10% free cash margin.

Speaker #9: Perfect. Very helpful. Thank you, guys.

Nelson Cox: Perfect. Very helpful. Thank you, guys.

Speaker #5: Thanks . Awesome .

Michael McGarrity: Thanks, Nelson.

Speaker #3: Again , if you have a question , please press star then one . Thank you everyone . The conference is now concluded . Thank you for attending today's presentation .

Operator: Again, if you have a question, please press Star, then one.

Michael McGarrity: All right.

Operator: Thank you, everyone. The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.

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