Earnings call transcript: MDxHealth Q3 2025 misses EPS forecast, stock falls

MDxHealth reported its Q3 2025 earnings, revealing a larger-than-expected loss per share and slightly lower-than-anticipated revenue, leading to a 7.42% drop in its stock price in after-hours trading. The company posted an EPS of -$0.16, missing the forecast of -$0.11, while revenue reached $27.4 million, falling short of the $28.12 million forecast. Despite these misses, the company showed notable year-over-year growth in key areas.

Key Takeaways

• MDxHealth's Q3 2025 revenue grew 18% year-over-year.
• Gross margins improved to 65.2% from 61.2% in Q3 2024.
• The company's stock dropped 7.42% in after-hours trading.
• MDxHealth maintained its 2025 revenue guidance at $108-$110 million.

Company Performance

MDxHealth demonstrated significant year-over-year growth in Q3 2025, with revenue increasing by 18% and gross profit up by 25%. The company's gross margins improved to 65.2%, reflecting operational efficiencies. The total billable volume of tests surged by 37%, driven by a 65% increase in liquid-based tests. Despite these positive trends, the company faced challenges in meeting its earnings expectations.

Financial Highlights

• Revenue: $27.4 million, up 18% year-over-year.
• Earnings per share: -$0.16, compared to a forecast of -$0.11.
• Gross profit: $17.9 million, a 25% increase from Q3 2024.
• Gross margins: 65.2%, up from 61.2% in the previous year.
• Adjusted EBITDA: $1 million, compared to -$3.8 million in Q3 2024.

Earnings vs. Forecast

MDxHealth reported an EPS of -$0.16, missing the forecast of -$0.11, resulting in a negative surprise of 45.45%. Revenue also fell short at $27.4 million against a forecast of $28.12 million, marking a surprise of -2.56%. This performance contrasts with the company's historical trend of meeting or exceeding forecasts in previous quarters.

Market Reaction

Following the earnings announcement, MDxHealth's stock fell by 7.42%, closing at $4.45 in after-hours trading. This decline reflects investor disappointment with the earnings miss and revenue shortfall. The stock's movement is notable as it approaches the lower end of its 52-week range of $1.35 to $5.33.

Outlook & Guidance

MDxHealth maintained its 2025 revenue guidance of $108-$110 million, signaling confidence in its growth trajectory. The company anticipates the ExoDx business to contribute around $20 million in 2026 and expects revenue growth to accelerate from 20% to nearly 30%.

Executive Commentary

CEO Michael McGarrity expressed optimism about the company's position in the urology diagnostics market, stating, "We are confident that no other company is better positioned to improve the patient journey through prostate cancer diagnosis and treatment." He also highlighted the company's commitment to quality and customer satisfaction, saying, "Our culture of quality first and customers always will ensure our building reputation for excellence."

Risks and Challenges

• The earnings miss could lead to increased scrutiny from investors and analysts.
• The competitive landscape, with players like Exact Sciences, remains challenging.
• The company's decision to pause entry into the germline market may impact future growth opportunities.
• Maintaining operational efficiency amid expanding sales and geographic coverage could pose challenges.

Q&A

During the earnings call, analysts inquired about the company's decision to pause its entry into the germline market. Executives explained that this move allows MDxHealth to focus on its core competencies and integrate recent acquisitions effectively. Additionally, questions about sales team expansion highlighted the company's strategy to enhance geographic coverage and improve sales productivity.

Full transcript - MDxHealth SA ADR (MDXH) Q3 2025:

Conference Moderator: Good morning, ladies and gentlemen, and welcome to the MDxHealth third quarter 2025 earnings conference call. At this time, all participants are on the listen-only mode. Following the presentation this morning, there will be a question-and-answer session. To ask a question, you will press star and then one on your touch-tone phone. To withdraw your question, you will press star and two. As a reminder, this call is being recorded. I would now like to hand over the conference to John Francis from LifeSci Advisors. Thank you, and over to you.

John Francis, LifeSci Advisors, LifeSci Advisors: Before we begin, I would 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 factor section of the company's filings with the Securities and Exchange Commission, specifically in the company's annual report on Form 20F. I'll now turn the call over to Michael McGarrity, Chief Executive Officer.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thanks, John. Thank you all for joining us for our third quarter 2025 earnings conference call for MDxHealth. With me today is Scott McMahon, 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 are excited to report results that are consistent with that internal mandate. From a focus perspective, we continue to identify high-value, differentiated assets, as demonstrated by our recent acquisition of the Exosome Diagnostics business, further positioning MDxHealth with the most comprehensive industry-leading menu of precision diagnostics in urology. From an initial elevated PSA to and through each point along the diagnostic pathway of prostate cancer, MDxHealth can deliver clinically actionable diagnostics for clinicians and patients.

With respect to execution, every operating group within our company has supported our growth with an uncommon discipline, as evidenced by the following. Our sales organization has delivered a compound annual growth rate of 45% over the last four years, while significantly reducing our sales and marketing expenses as a percentage of revenue. This reflects our team's steadfast commitment to building trust and accountability with our urology customers, allowing us to confidently invest in additional growth opportunities. Our laboratory operations group has also kept pace with the increasing scale of our business while improving our gross margin profile through optimal efficiency and productivity. From a customer experience perspective, our entire team knows that we are only as good as our customers think we are. The emphasis we place on the customer experience has, in fact, become foundational to our culture.

There is nothing we do not metric and manage to help improve upon the customer experience. Through these efforts, I believe we are now resetting the industry gold standard for turnaround time from sample to result, which is clearly one of the most important, patient, and clinician-driven metrics. Finally, as it relates to 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 achieve sustained top-line growth while advancing operating profitability following our first adjusted EBITDA profitable quarter in Q2, delivered again in Q3, as well as achieving positive adjusted EBITDA on a year-to-date basis. I would now like to highlight the results from our third quarter that we believe reflect our focus, execution, and growth.

Q3 revenue of $27.4 million represents 18% growth over 2024, even with our decision to forgo focus on our previously planned germline offering, and adjusted EBITDA came in at $1 million. Our total OPEX is essentially flat for Q3 and year-to-date over 2024, up a mere 1% on 20% year-to-date top-line growth while absorbing material acquisition-related expenses. We successfully closed on the transformative ExoDx acquisition, and at the end of Q3, we began the integration from an operational and salesforce perspective. This process will be our highest priority throughout Q4. We strengthen our laboratory operation with now three labs, and we'll focus on installing and advancing our quality and operating discipline goals with the team from ExoDx in the Massachusetts facility. Finally, our total use of cash for Q3 was less than $1 million. We are confident in completing the integration of the ExoDx acquisition in this fourth quarter.

The integration will be focused on the following key operational areas of the business. For the commercial operation, our diligence of the ExoDx opportunity led us to execute a strategic expansion of our sales organization from 50 direct sales reps among six geographic regions to now 60 direct sales reps across eight regions. This expansion was informed by a detailed review of the customer base and ordering patterns by urologists and large urology groups, and was specifically designed to optimize cross-selling opportunities of our combined customer base. As I noted, when we announced the acquisition, this strategy mirrors the growth thesis of our GPS acquisition, leveraging the potential to drive growth through our now expanded menu and customer base. We are conducting cross-training of sales reps and integrating into the newly formed regions.

Through this acquisition, we are confident that our best-in-class sales team will continue to execute on our growth strategy demonstrated by our track record of consistent and sustainable sales rep productivity. Fortified by the high-performing and high-quality sales reps we retained from ExoDx, slotting them opportunistically to further drive growth and customer engagement. Lastly, on the commercial customer front, we will be converting our SelectMDx customers over to ExoDx throughout Q4 and would expect to discontinue SelectMDx by year-end. We are confident, as we have noted, that the ExoDx test provides optimal and clinically actionable results for patients and clinicians while providing additional ease of use. We will strive for seamless integration and provide an update at the beginning of the year on our progress and what we expect to be a successful transition.

We are also focused on our laboratory operational integration with our expanded laboratory operations in California, Texas, and now Massachusetts. We will focus on efficiencies designed to advance our continuously improving gross margin, as well as advancing our information systems to drive additional operational efficiency, all while maintaining our relentless focus on performance metrics that achieve operating excellence and improve customer experience. Finally, we are integrating our client service and revenue cycle management teams to best serve our patients, customers, and payers as we strive for world-class service standards within the industry. Based on prioritizing the successful integration and customer engagement, as well as conversion of SelectMDx to ExoDx, we have set aside our entry into the germline market.

While we had expected material revenue contribution from germline in the second half of this year, we are maintaining our 2025 revenue guidance of $108-$110 million and will revisit and reevaluate the germline opportunity as we enter 2026. Finally, as part of the ExoDx acquisition, we commented on the broad IP and clinical scientific data in multiple cancers, including prostate. We will be actively evaluating strategic opportunities from this platform, both within MDxHealth as they apply to our urology focus and through partnering opportunities as they may present themselves. We now believe and are confident that no other company is better positioned to improve the patient journey through prostate cancer diagnosis and treatment, and that our results continue to reflect our success in bringing value to this patient population.

I will follow up with closing comments and a view forward, but first, let me turn the call over to Scott McMahon for a review of our financial and operating results for our third quarter. Scott?

Scott McMahon, Interim Chief Financial Officer, MDxHealth: Thank you, Mike. To follow on Mike's remarks, we are very pleased to report strong performance in the third quarter of 2025. Q3 total billable volume was approximately 33,000 tests, of which approximately 13,000 were tissue-based and 20,000 were liquid-based tests, representing total unit growth of 37% versus the prior year quarter. Volumes for our tissue-based tests, which include ConfirmMDx and GPS, increased approximately 18% over the prior year period. Volumes for our liquid-based tests, which include SelectMDx, ResolveMDx, Germline, and the newly acquired ExoDx, increased approximately 65% over the prior year quarter. Revenues for the third quarter ended September 30, 2025, increased by 18% to $27.4 million versus $23.3 million for the prior year quarter. Tissue-based tests made up 76% of revenues for Q3.

Moving below the revenue line, our gross profit for the quarter was $17.9 million, an increase of 25% as compared to $14.3 million for the third quarter of 2024. Gross margins were 65.2% compared to 61.2% for Q3 2024. An increase of four percentage points is primarily attributed to our test mix and improved efficiencies in our operations. Our operating loss for the quarter declined 57% to $2.6 million compared to $6.1 million for the third quarter of 2024, primarily driven by our growth in sales and gross profit. Our net loss decreased 28% to $8 million compared to $11.2 million for the prior year. Adjusted EBITDA for the quarter was a positive $1 million compared to a negative $3.8 million for the third quarter of 2024. Note that a reconciliation of IFRS to non-IFRS financial measures has been provided, and the tables included in this press release.

Cash and cash equivalents as of September 30, 2025, were $32 million. This concludes my overview of the results. I will now turn the call back to Mike.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thanks, Scott. We believe our Q3 results reflect the reputation we are building for excellence in focus, execution, and growth. As we look forward, we are committed to excellence in the following operating principles: discipline in our capital allocation, as reflected in the linear decline in cash used in operations, with Q3 almost breaking even with respect to total use of cash; 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 will continue to fuel our growth in a sustainable way. 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 salesforce, 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.

Conference Moderator: Thank you. We will now begin the question-and-answer session. To ask a question, you may press star and then one on your touch-tone phone. 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 and then two. At this time, we'll pause momentarily to assemble our roster. We have the first question from the line of Dan Brennan from TD Cowen. Please go ahead.

Dan Brennan, Analyst, TD Cowen: Great. Thank you. Thanks for the questions. Maybe just the first one. Just on Exo in the quarter, it looks like, given the liquid volumes, really had a strong liquid quarter. Just wondering if you can give us any color on the contribution of Exo in the quarter. B, related to that, there are some moving pieces, obviously, with your product portfolio as we exit the year. You're exiting germline. You're de-emphasizing Select, but now you have Exo in there. We would net those all out to still be a positive contributor such that you should see upside to revenues. You guys are not baking anything in right now, maintaining the guide. Is there conservatism in that? Or anything you can help on that would be really great.

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah, Dan, I got the question. Just to be clear, to take a step back, we had, as we had discussed, not expected material contribution from germline in the first half of this year. We did, however, signal and expect material contribution from germline in Q3 and Q4. As we entered into the process on the ExoDx acquisition, it became clear that that would likely lead to a successful outcome. We adjusted that focus knowing that we would need to require all of our resources, focus, and attention on the closing of the deal, which happened at the end of Q3. Part of your question is no material contribution from Exo, and that that is an offset. Without any contribution from what we expected from germline and a Q4 contribution from Exo, we're confident that we can meet or exceed our revenue guidance.

That informs our view there and hopefully answers your question, which I understand. We are very clear that the transition, the liquid growth in Q3 was candidly driven by our germline—I'm sorry, our Resolve business continues to accelerate. We did see we announced the deal in August. We did not close till the end of September. We really were focused on managing. I communicated when we announced the acquisition that I was not going to comment on our strategy for Select and Exo in the market out of respect for our customers and sales reps that were working that. We are confident that we navigated through that weird period, for lack of a better term, with a lot of competitors running around and making assumptions that we held off.

We believe that our results for the year in Q4 will reflect our original thesis on the opportunity ahead of us with the ExoDx acquisition. The offset of germline, we believe, is the right strategy to ensure very, very successful integration of an expanded sales organization with territory adjustments, cross-training, and maintaining the customer base while we move customers away from SelectMDx and onto ExoDx. Hopefully that answered your question. Yeah, we think we made the right decisions there, and obviously, we'll look forward to reporting support for those.

Dan Brennan, Analyst, TD Cowen: Okay. Maybe any color just on GPS, obviously, such a big driver of revenue for the company, just given the ASP you realize on that. Just wondering what you could characterize how GPS did in the quarter. We were tracking volumes up significantly over the last couple of quarters. Any color on how it came in, any color on price or volume, or just what the environment's like, and then what do you have kind of baked in as we think about GPS for the fourth quarter?

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah. So our tissue reported 18% growth. We feel that that's significantly ahead of the market growth, and we're very confident that our performance continues there with no material change to the economics. And remember, that is ConfirmMDx and GPS. In Q3, we did—I usually do not comment on seasonality. We did, and our customer channel checks throughout the quarter see a little bit of a patient flow-directed slowdown in number of biopsies. But again, we would not tend to apologize for 18% growth on the tissue side. Business is going as we anticipated and feel confident in both. I think the comment I would make is the mix shift that you saw with tissue and liquid, we view as very encouraging. In other words, our tissue as a weighting of revenue had been running about 80%. The last two quarters, it was up to about 85% of revenue.

What you saw in Q3 was a little bit of a flip of that, really driven by the strength of the Resolve growth. Yet the margin held at the 65%, which is, as I have said on the last couple of calls, ahead of our expectations. I have been reluctant to set that as the view forward, but obviously, it shows confidence that we are seeing really good execution and efficiencies in our COGS and gross margin profile across our menu, both liquid and tissue. We believe that is sustainable as well.

Dan Brennan, Analyst, TD Cowen: Great. Maybe just a final one, just back to the first point. Presumably, whatever the Exo contribution is, given the fact you're holding the guide, is the assumption that that contribution is around the same level—is around the same level as the germline test on the Select test, or has something changed in your underlying assumptions for the rest of the business? Thank you.

Michael McGarrity, Chief Executive Officer, MDxHealth: The former, not the latter. We are still very, very confident in not only the core Exo business that we acquired. It's early. As we go forward over the next two or three quarters, we'll comment on what we see as a real opportunity there with the expanded sales organization and a renewed focus on that part of our market opportunity because I don't want to say we had walked away from it, but we were clearly challenged. As I've commented, our focus for the first half of the year was really leading toward the tissue. I think our Resolve business is just really going based on our sales rep focus, but also a little bit of peer-to-peer help there. We're probably on our fifth generation of that test. It's the best test, we believe, on the market unequivocally.

We really see balanced growth throughout the menu with just an adjustment in our strategy that lines us up where we expected to be for the year.

Dan Brennan, Analyst, TD Cowen: Okay. Great. Thank you.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thanks, Dan.

Conference Moderator: Thank you. We have the next question from the line of Andrew Brackman from William Blair. Please go ahead.

Andrew Brackman, Analyst, William Blair: Hey, guys. Good afternoon. Thanks for taking the questions. Mike, you mentioned the analysis that you did of your customer bases, and that's informing some of the sales team expansion here. Any additional color you can maybe give on that analysis, how you're viewing the opportunity across the combined customer bases here, and how we should be thinking about the total opportunity size? Thanks.

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah, Andrew. Probably what you would expect, right? I mean, we tried not to overcomplicate it, but what we did was we looked at their customer base, and we had pretty good information. I'll just say a little bit different than the GPS. That was a carve-out asset acquisition. This was an acquisition of the business. Between signing and closing, we did a lot of work on the customer base across over. What we really looked at was growth trends within an area of the business, and then also looking at where there was Exo business where we saw our opportunity to build our tissue side, GPS and Confirm, and vice versa. The second comment I would make on that is that we know a lot of those customers because, candidly, they are former Select customers over the past few years as the market has moved on us.

We really took a composite view of, A, sales talent, B, historical ordering trends, and then crossover mix of our menu within our target customer base. That informed the expansion, which we think was the right number, proved in its strength amidst our focus. We expect to drive that same productivity now over a little bit larger sales organization while still being able to carry our P&L forward with all the progress we've made on the full P&L from an OpEx absorption and productivity across the sales organization.

Andrew Brackman, Analyst, William Blair: Oh, that's great color. Just on the integrating client service and RCM initiatives here, just on the operations front, can you maybe just sort of talk to us about the opportunity that's there on the RCM? Why did you choose to do this now, and how we should sort of think about the potential downstream effects? Thanks.

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah. I guess I called that out just because what we retained and crossed over from the business were the key operating parts of the business, right? Salesforce set aside, we saw, we'll recognize synergies there based on the size of the sales organization they were carrying and what we elected to take over. We ran a really high quality, which was important to us, to me, really looking at each rep, each territory, each customer base. My comment there is just the three key parts of the business that we have to be and plan to be very successful integrating to our operating business is the laboratory operation, which is with us now, the client services group, and the revenue cycle management group.

My comment stands to be integrating those so that we're all working the same process, focus, and execution and expectations so that we can predict and protect the business as well as we have over the last number of quarters and years. That'll be the sole focus in Q4. When we come back at the beginning of the year and provide guidance for 2026, it will be informed across all of the aspects that drive the P&L, right? The top-line unit growth, our coverage in cash collections, and then how we support our customers through our client service group with a menu that is more advanced than some of our competitors with four tests being ordered in a different mix set by certain customers as well. All that is what we're focused on for Q4.

That constitutes the new people and parts of the organization that are coming over that we expect in a quarter or two to be fully integrated, just as we have made progress over the last couple of years with our group that I hope I pointed to with the growth not being linearly offset by our spend on the outback side. That is what we anticipated over the last number of quarters. We have had 1% outback expansion over the last year on 20% top-line growth. That we expect to continue. Those are the groups that we have to make sure that we integrate so they are operating at the same efficiency levels that we have.

Andrew Brackman, Analyst, William Blair: Okay. All helpful. Thanks, guys.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thanks, Andrew.

Conference Moderator: We have the next question from the line of Bill Bonello from Craig-Hallum. Please go ahead.

Bill Bonello, Analyst, Craig-Hallum: Hey, guys. Thanks a lot. A few follow-up questions here. First of all, if we're doing our math right, it looks like maybe on the tissue side that the ASP was down about 7% or so sequentially. I guess, does that sound about right? If so, is that a function of mix between the tests? If it's not a function of mix, sort of what's driving that move?

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah. I mean, Bill, we don't report our ASP by tests, and we see variability each quarter. As we go forward, we don't see a material change in our view of really our entire menu consolidated or how we think about our payer mix. We'll continue to report on that each quarter, but I don't view that as anything notable.

Bill Bonello, Analyst, Craig-Hallum: Okay. Because, Mike, even if I just look at the total tests and total revenue, the ASP was down quite a bit year over year and sequentially as well. It is just a little confusing. There is that much fluctuation from quarter to quarter?

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah, Bill. We are very, very conservative on our revenue cycle management estimates as you run in the lab model. So we do not have any additional comment on that.

Bill Bonello, Analyst, Craig-Hallum: Okay. I guess I just sort of want to come back to the guidance again because much like Dan, I think we had sort of assumed that the guidance would go up when you closed the acquisition. Shame on us for not realizing you had that much germline baked into the initial guidance. At the time you announced the ExoDx acquisition you talked about assuming it would add at least $20 million of revenue next year. Has anything changed on that front thus far?

Michael McGarrity, Chief Executive Officer, MDxHealth: Nothing has changed. If you view that offset as that we expected $5 million or a little bit more in germline in the second half, that would be a good assumption because we do not guide to products, but we would not have communicated we saw an opportunity there if we did not intend to focus on it and execute and deliver. We do not feel that is the right use of our focus, particularly over the next couple of quarters. You are reading it right. Absolutely, zero change on our view of the opportunity of the contribution from Exo as we go forward.

Bill Bonello, Analyst, Craig-Hallum: That's helpful. I know you're not going to give 2026 guidance, and you might not even answer this, but I'll ask it anyway. When you first sort of put that out there, the way we had thought about this was, "Gosh, you're sort of a 20% grower, and we tag $20 million or whatever the actual number is on top of that from the acquisition." It sounds like maybe that's the wrong way to be thinking about it, and we should sort of be thinking $20 million, and we net out $10 million of kind of lost germline. Net-net, maybe the real add is sort of $10 million to whatever the basic growth rate is. How are you kind of thinking about that?

Michael McGarrity, Chief Executive Officer, MDxHealth: I think I had a really smart analyst once tell me, "Don't guide to the following year until it's time to guide to the following year." I think what I said was we expected.

Bill Bonello, Analyst, Craig-Hallum: That must have been Dan.

Michael McGarrity, Chief Executive Officer, MDxHealth: I think I stand by our view that we made that we expected the Exo business could contribute $20 million or more in 2026. That was a view, not guidance, not intended to be guidance, I should say. That view is unchanged. I also said that I expected it to accelerate our revenue growth from 20% to close to 30%. Again, that was our view. It was not intended to be guidance. When we provide guidance at the beginning of 2026, I think our view from today is that those are reasonable in the ballpark assumptions of how our business builds.

Bill Bonello, Analyst, Craig-Hallum: That is particularly helpful. I appreciate that. As always, we appreciate your prudence.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thank you, Bill.

Conference Moderator: We have the next question from the line of Mark Massarow from BTIG. Please go ahead.

Mark Massarow, Analyst, BTIG: Thanks, guys. I enjoyed that discourse in the last round of questions. I think I'd like to maybe ask this one, which is, Mike, I understand that the ExoDx test is certainly an attractive test. You've got many other attractive tests in your bag. I wanted to just get your temperature on the germline test. I recognize that you'll reevaluate that next year. My sense is that you saw something in the marketplace, whether it was the competitive environment or just demand. Yeah, I mean, couldn't you just maybe give us a little more? Why are you sort of setting this test aside?

Michael McGarrity, Chief Executive Officer, MDxHealth: Yeah. I get the question for sure, Mark. Just to be clear, we see that as a market opportunity that makes sense for our business, our offering, right? We have competitors, non-competitors, partners. If you look at, you can name them probably better than I, but everybody from Exact Sciences to a couple of our competitors offer that. Having that, but candidly, in a non-materially differentiated way, the way we anticipated, which we have, I think, a good track record for, is when we have our sales organization, and I'll speak to it individually, our sales reps that I think have built access, influence, and sway. Please take that as a respectful term, but that's how you build. Everything I say about our organization being focused on the customer experience, that's how we've built that.

Our assumption and thesis on that was it's an offering that makes sense. If you look at our ResolveMDx test, I mean, everybody's got a Resolve or, I'm sorry, a UTI test is not unique. What we've been able to do with that business is driven by, yes, we think the best test for complex infections in our patient population within urology. We've continued to innovate that test. I think we're on our fourth or fifth generation. When that started to go was when we really pushed it into our sales organization. We elected not to push that into our sales organization.

Our view of what we could accomplish and achieve in that was somewhat extrapolated by our experience and the way we see customer adoption go from zero to material contribution and growth of a product that is not maybe as proprietary as ConfirmMDx, GPS, and ExoDx. That was our view. We just chose not to have our reps spend time on that in the first half, as I noted, for the reasons I stated. We made a late decision to forgo it in the second half. Per the math, the implied math question, if you made the assumption that we expected it to contribute the delta between where you might have thought we would be with $5 million in ExoDx in Q4 and not taking up guidance, to be clear, that is the question. I get it.

Yeah, that's a good assumption that we feel like if we roll that out at the beginning of Q3 to our sales team, that we'd be able to drive that type of adoption. You have to remember we have sales reps now that need to be cross-trained, adjusted to modest. Every time you adjust territories as a former sales rep, they're always viewed as material, not like with the GPS when we doubled our sales organization. We deemed that that was the appropriate way to cement our investment in this asset. We don't see the germline market as going away. As I noted, we'll revisit that. Hopefully, that's a fair answer to your question.

Mark Massarow, Analyst, BTIG: Yeah. Yep. That's great. Yeah, gross margins were really strong, over 65%, up about 400 basis points in the quarter. I wanted to ask, if we take Exo and just sort of annualize it out, do you expect Exo to be accretive to gross margins in 2026? Another way to think about it is, is 65% a level that you feel comfortable with executing against, or are there some mix factors that we should be thinking about for next year?

Michael McGarrity, Chief Executive Officer, MDxHealth: I anticipated that question coming from you, Mark. I think we'd like a full quarter of Exo. I had said that our expectation was that it would be neutral to accretive to gross margin. We have no reason to change that view. I think we want to see a quarter or two of mix. As I referred, integrating, as we fully come over in Q4, there will be all the financial integration as well, right? Working capital, revenue cycle management, different payer mix, different collection profiles. We believe that maintaining our guidance reflects confidence that that all holds together. Again, I'd probably wait till the beginning of the year so that I can give you a clear view, an informed fact-based view of 2026. I'm just saying, give us a quarter and a half or so to get this locked. I've said I did.

That the gross margins running ahead of has run ahead of our expectations. I'm beginning to think that we can see that continue, but we'll lock that at the beginning of the year.

Mark Massarow, Analyst, BTIG: Okay. That is helpful. One last one for me. When we think about your new commercial team, was this as simple as—just correct me if I'm wrong—was this as simple as taking your 50 direct reps and adding 10 from Exo? Or was there some other MDx reps that might have been impacted, and perhaps you added more than 10 from Exo? Can you speak to the experience and tenure of the Exo reps? What early indicators are you seeing from those newer folks?

Michael McGarrity, Chief Executive Officer, MDxHealth: Too early to comment on the last part of your question. The front part of your question, really no comment on that. We would not comment on specific people within our organization pre-acquisition or post-acquisition. The net acquisition was 10 direct reps. When we look at our sales organization individually and collectively, we really went through that process. We analyzed and credit to our commercial team. This I can share. We put every one of their sales reps through our process as if we were hiring a new rep. I will not speak to them individually out of respect for those that came over, those that did not in our sitting sales organization going into the acquisition. I will say that we were in a really tight process there. That gives us confidence. We learned a lot from the GPS acquisition. I was very open about that.

That was more complicated than we anticipated. It took longer than we anticipated. We're trying to take that experience and apply it here so that we really, when we provide our view for it being in next year, we'll be informed with, granted, only a quarter. We're working on that right now.

Mark Massarow, Analyst, BTIG: Great. Thanks very much.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thank you, Mark.

Conference Moderator: Thank you. We have the next question from the line of Thomas Flatten from Lake Street Capital. Please go ahead.

Michael McGarrity, Chief Executive Officer, MDxHealth: Hey, good afternoon. Appreciate you taking the question. Hey, Mike, just to confirm. With the new 10 reps coming over, was this a question of adding two new white space territories, or were you splitting and subsegmenting existing territories, or maybe a combination of both?

Yeah. We really do not have white space pre-acquisition, right? We design our number of reps is designed to cover the full geography of the U.S. I would say it was probably more a function of putting strength on strength, right? I want to wear you out with my Stryker experience, right? Add strength with strength. We looked to do that. We were also opportunistic where we saw, as you would expect, strength in a customer base in a particular territory where maybe we had not been performing as well as we expected. That was all part of our calculus there. It is not complicated like you would not understand it, but it was complicated to make sure that we went through the exercise so that we did not have it. Yes, the embedded question was, did territories change? Yes.

When you go from 50 to 60 and you're fully covered without white space, yeah, there were territory adjustments. Not as.

Mark Massarow, Analyst, BTIG: Got it.

Michael McGarrity, Chief Executive Officer, MDxHealth: Not as. Yep.

Mark Massarow, Analyst, BTIG: Yeah. I realize this question is probably a lot early given how early it is since the acquisition closed. Any negative feedback or pushback from Docs making the switch from Select to Exo? I do not know how you have been messaging that to Docs that you are in the process of doing that.

Michael McGarrity, Chief Executive Officer, MDxHealth: Too early to comment, but we're confident that that will not create friction or tension on our customer base.

Mark Massarow, Analyst, BTIG: Okay.

Michael McGarrity, Chief Executive Officer, MDxHealth: Anyway, please take this the other way.

Mark Massarow, Analyst, BTIG: Appreciate it.

Michael McGarrity, Chief Executive Officer, MDxHealth: It is somewhat informed by the customers that are already converted involuntarily from SelectMDx to ExoDx. It is just a better test today.

Mark Massarow, Analyst, BTIG: Yeah. Got it. Appreciate it. Thanks.

Michael McGarrity, Chief Executive Officer, MDxHealth: Thank you, Thomas.

Conference Moderator: Thank you. Ladies and gentlemen, this concludes our question-answer session. The conference call is now concluded. Thank you for attending today's presentation. You may now disconnect.

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