Earnings call transcript: Xtant Medical Q3 2025 sees earnings beat and stock surge

Xtant Medical Holdings Inc. (XTNT) reported its third-quarter 2025 earnings, showcasing a surprising turnaround with an earnings per share (EPS) of $0.01, surpassing the forecasted loss of $0.01. This unexpected performance led to a significant premarket stock surge of 7.75%, reaching $0.82. The company’s revenue also exceeded expectations, coming in at $33.3 million against a forecast of $32.7 million, marking a 19% year-over-year increase.

Key Takeaways

• Xtant Medical reported an EPS of $0.01, beating the forecasted loss.
• Revenue increased by 19% year-over-year, reaching $33.3 million.
• Stock surged by 7.75% in premarket trading following the earnings release.
• The company launched new products, enhancing its orthobiologics portfolio.
• Operating expenses were reduced, contributing to improved profitability.

Company Performance

Xtant Medical demonstrated a robust performance in Q3 2025, reversing its previous year’s net loss of $5 million to a net income of $1.3 million. The company benefited from a 19% increase in revenue, driven by licensing and biologics revenue, despite a decline in hardware product sales. This performance aligns with the growing trends in the orthobiologics and surgical repair markets, where Xtant is strengthening its competitive position.

Financial Highlights

• Revenue: $33.3 million, up 19% year-over-year
• EPS: $0.01, compared to a loss of $0.01 forecasted
• Gross margin: 66.1%, up from 58.4% in the previous year
• Adjusted EBITDA: $4.5 million, compared to a loss of $1 million in 2024
• Operating expenses reduced to $19.5 million from $20.1 million

Earnings vs. Forecast

Xtant Medical’s Q3 2025 earnings exceeded expectations with an EPS of $0.01, a significant surprise given the forecasted loss. The revenue of $33.3 million also surpassed the anticipated $32.7 million, reflecting a positive 1.71% surprise. This performance marks a notable shift from previous quarters, highlighting the effectiveness of the company’s strategic initiatives.

Market Reaction

Following the earnings announcement, Xtant Medical’s stock rose by 7.75% in premarket trading, reaching $0.82. This surge reflects investor optimism about the company’s turnaround and future prospects. The stock’s movement is significant, considering its 52-week range of $0.331 to $0.95, and indicates a positive market sentiment.

Outlook & Guidance

Xtant Medical has set a revenue guidance of $131-$135 million for 2025, anticipating 11-15% growth. The company expects low double-digit growth in its orthobiologics segment for 2026. Additionally, a pending sale of non-core assets to Companion Spine for $19.2 million is expected to help reduce long-term debt, further strengthening the company’s financial position.

Executive Commentary

CEO Sean Browne emphasized the company’s focus on profitability and innovation, stating, "Profitability is the most important thing we’re going to do right now." He also highlighted the launch of the Trivium advanced demineralized bone matrix as a key product innovation, reinforcing Xtant’s commitment to expanding its product portfolio.

Risks and Challenges

• Potential supply chain disruptions could affect product availability.
• Market saturation in certain segments may limit growth opportunities.
• Macroeconomic pressures could impact consumer spending and healthcare budgets.
• Regulatory changes in reimbursement policies could affect revenue streams.
• Competition from larger medical device manufacturers remains a significant challenge.

Q&A

During the earnings call, analysts inquired about the expansion of Xtant’s commercial team and the performance of different product lines. The company addressed potential impacts of reimbursement changes and highlighted its focus on new product innovations, indicating a proactive approach to market challenges.

Full transcript - Xtant Medical Holdings Inc (XTNT) Q3 2025:

Conference Operator: Good morning, everyone, and welcome to the Xtant Medical third quarter 2025 financial results. At this time, all participants are in a listen-only mode, and the floor will be open for questions following the presentation. If anyone should require operator assistance during this conference, please press star zero on your phone keypad. Please note this conference is being recorded. I will now turn the conference over to your host, Kevin Gardner of LifeSci Advisors. Kevin, the floor is yours.

Kevin Gardner, LifeSci Advisors, LifeSci Advisors: Thank you, Operator, and welcome to Xtant Medical’s third quarter 2025 financial results call. Joining me today are Sean Browne, President and Chief Executive Officer, and Scott Niels, Chief Financial Officer. Today’s call is being webcast and will be posted on the company’s website for playback. During the course of this call, management may make certain forward-looking statements regarding future events and the company’s expected future performance. These forward-looking statements reflect Xtant’s current perspective on existing trends and information and can be identified by such words as expect, plan, will, may, anticipate, believe, should, intends, and other words with similar meaning. Such forward-looking statements are not guarantees of future performance and involve risks and uncertainties, including those noted in the risk factor section of the company’s annual report on the Form 10-K filed with the SEC and in subsequent SEC reports and press releases. Actual results may differ materially.

The company’s financial results press release and today’s discussion include certain non-GAAP financial measures. Please refer to the non-GAAP to GAAP reconciliations, which appear in our press release and are otherwise available on our website. Note that the Form 8-Ks that we file with our financial results press releases provide detailed narratives that describe our use of such measures. For the benefit of those who may be listening to a replay, this call was held and recorded on November 11th at approximately 8:30 A.M. Eastern Time. The company declines any obligation to update its forward-looking statements except as required by applicable law. Now, I’d like to turn the call over to Sean Browne, CEO. Sean?

Sean Browne, President and Chief Executive Officer, Xtant Medical: Thank you, Kevin, and good morning and happy Veterans Day to all those who have served or are serving. One quick note, since today is Veterans Day, the SEC is closed, although, as you know, the market is open, and so we released our 10-Q last night. With that behind us, thank you for joining our third quarter update call. As has been our practice, I will begin with a few prepared remarks about our operations, and then Scott will provide a deeper dive into the financials. We’ll then open the call to your questions. We again turned in solid financial performance during the third quarter, highlighted by 19% revenue growth over the third quarter of 2024. We again generated positive cash flow, adjusted EBITDA, and net income, and a continuation of the favorable trends that we’ve seen over the past few quarters.

Before covering the quarter in detail, however, I would like to begin the morning with an update on the pending sale of our non-core Coflex and Cofix interlaminar stabilization implant assets in all international entities of Paradigm Spine to Companion Spine. The proceeds of the transaction, when completed, are anticipated to be $19.2 million in total. We intend to use the proceeds to reduce our long-term debt and to provide additional cash liquidity. Importantly, as a result of this transaction and the cash flow we are generating from operations, we do not expect to require additional external capital to fund our operations from this point forward. This transaction will be truly transformational, one for our company, as it will further enhance our focus on our core biologics business while strengthening our financial position. In terms of timing, we anticipate we’ll close by the end of the year.

It is worth mentioning that the Scoliosis Brothers have already paid us approximately $7.5 million, including a $2.5 million payment just last week toward the total consideration of this deal. They are as committed as we are to ensuring its completion. As a reminder, the business included in the sale generates annual revenue to Xtant of approximately $23.5 million. As previously mentioned, these products were modestly unprofitable on a standalone basis, so the effect of the sale on our margins and bottom line metrics is anticipated to be neutral to slightly positive in 2026 and beyond. In the meantime, until this transaction closes, we continue to support those products in the field, and we will benefit from the associated hardware revenue for an additional few months. Now, turning now to our third quarter, I’m pleased to report that we delivered strong financial and operating results.

Scott will cover the financials in detail in a moment, but I’d like to begin by touching on a few highlights. First, our total revenue for the quarter was $33.3 million, which represents a growth of more than 90% versus the third quarter of 2024. Notably, our third quarter 2025 revenue includes $5.5 million of licensing revenue pursuant to the license agreement for Q-Codes and the Simply Maxx dual-layer amniotic membrane that we announced in the third quarter of last year. As we indicated in Q1, CMS has extended the local coverage termination for skin substitutes to December 31, 2025. Our biologics product family, which is our core business, grew 4% over the third quarter of last year. This was below our long-term expectation for growth in the biologics product family.

However, it is important to take a step back and recall that our focus over the past several quarters has been on prioritizing self-sustainability, particularly positive cash flows. As part of our long-term growth strategy, the strategic initiatives that we have implemented are sharpened focus on higher margin biologics, our emphasis on in-house manufacturing to improve quality and control costs, and our more disciplined approach to operating expenses were all implemented with self-sustainability in mind. With those goals now achieved, we are turning our focus back to driving top-line growth in our orthobiologics business. We continue to invest in R&D to bring innovation to surgeons and their patients. At the same time, we have started making investments in our commercial team to maximize the reach of our broad portfolio of orthobiologic solutions.

From a new product launch perspective, since our last quarterly update, we also continue to innovate to bring new orthobiologic solutions to surgeons and their patients. Earlier this month, we announced the commercial launch of CollagenX, our bovine collagen particulate product for surgical wound closure that is designed to promote healing, prevent dehiscence, and help mitigate concerns related to surgical site infections. CollagenX complements our existing orthobiologics product line, as it represents a potential addition to every case type that our portfolio currently addresses, as well as procedures performed in other surgical disciplines. This is the latest example of our commitment to innovation as we work to meet the diverse needs of our surgeons and patients. As a reminder, we now offer and internally produce solutions across all five major orthobiologic categories: demineralized bone matrix, cellular allografts, synthetics, structural allografts, and now growth factors.

Additionally, with our amnio and collagen product lines, we are well-positioned to grow in the surgical repair and wound care markets. This positions us as the partner of choice in the field of regenerative medicine, a position that has been further solidified by the very positive feedback that we have received from surgeons on these recent innovations. Now, turning to 2025 revenue guidance, recall that last quarter reflecting the heightened levels of licensing revenue from the previously noted Q-Code and amniotic membrane agreements that we are experiencing, we increased our full year 2025 revenue guidance to a range of $131 million-$135 million, which represents growth of approximately 11%-15% over 2024 revenue.

With the sale of our non-core Coflex and Cofix spinal implant assets in OUS business to Companion Spine, now anticipated to close closer to the end of the year, we are reiterating our 2025 revenue guidance at this time. We anticipate providing initial 2026 revenue guidance concurrent with our Q4 results in March of next year. With that, I will turn the call over to Scott for a more detailed review of our financial results.

Scott Niels, Chief Financial Officer, Xtant Medical: Thank you, Sean, and good morning, everyone. Total revenue for the third quarter of 2025 was $33.3 million, compared to $27.9 million for the same period in 2024. The 19% increase is attributed primarily to $5.5 million of licensing revenue during the third quarter of 2025 that Sean alluded to earlier, as well as $576,000 of additional biologics revenue, partially offset by a 6% or $736,000 year-over-year decline in hardware product revenue. Gross margin for the third quarter of 2025 was 66.1%, compared to 58.4% for the same period in 2024. The increase is primarily attributable to favorable sales mix in greater scale. Third quarter 2025 operating expenses were $19.5 million, compared to $20.1 million in the same period a year ago.

The reduction in operating expenses is primarily attributable to reduced compensation and commission expenses, which were partially offset by an increase in professional fees related to sales and marketing. General and administrative expenses were $7.1 million for the three months ended September 30, 2025, compared to $7.5 million for the same period in 2024. The decrease is primarily attributable to $500,000 of reduced stock-based compensation expense and $500,000 of reduced retention and severance expense, partially offset by a $500,000 increase in bonus expense. Sales and marketing expenses were $11.7 million for the three months ended September 30, 2025, compared to $11.9 million for the same quarter last year. The decrease is primarily due to a reduced commission expense of $700,000 resulting from revenue mix, partially offset by $1 million of additional consulting fees during the current year period.

Research and development expenses were $634,000 for the three months ended September 30, 2025, a decrease from $701,000 in the third quarter of 2024. Net income in the third quarter of 2025 was $1.3 million or $0.01 per share on a fully diluted basis, compared to a net loss of $5 million or $0.00 per share in the comparable 2024 period. Adjusted EBITDA for the third quarter of 2025 was $4.5 million, compared to an adjusted EBITDA loss of approximately $1 million for the same period in 2024. As a reminder, beginning in the fourth quarter of 2024, we no longer include the exclusion of the phasing of the bargain purchase gain on our sell-through of inventory acquired as part of our purchase of Surgiline Holdings Hardware and Biologics business in our calculation of adjusted EBITDA. Prior periods have been recast to conform to the current calculation.

The related effect on adjusted EBITDA was a reduction of $773,000 in the third quarter of 2024 to arrive at the recast amount. As of September 30th, 2025, we had $10.6 million of cash, cash equivalents, and restricted cash. Net accounts receivable was $25.6 million, inventory was $40.7 million, and we had $5.7 million available under revolving credit facilities as of the end of the quarter. As a reminder, our cash balance as of the end of the third quarter does not take into account the anticipated remaining proceeds from the pending sale of certain assets to Companion Spine that we anticipate closing by year-end that Sean discussed earlier. Operator, you may now open the line for questions.

Conference Operator: Thank you very much. We are now opening the floor for questions. If you would like to ask a question, please press Star 1 on your phone keypad now. A confirmation tone will indicate that your line is in the queue. You may press Star 2 if you would like to remove your question from the queue. For anyone using speaker equipment, it might be necessary to pick up your handset before you press the keys. Please wait a moment while we poll for questions. Thank you. Thank you very much. Our first question is coming from Ryan Zimmerman of BTIG. Ryan, your line is live.

Ryan Zimmerman, Analyst, BTIG: Thank you, and good morning, everyone. Appreciate the commentary and everything. Maybe I wanted to start, Sean, you talked about making some investments in the commercial organization. It would be good just to know, do you want to get more feet on the street? I mean, is this refilling the pipeline? Maybe talk to us a little about kind of a little more color on kind of what that means. My second question, I’ll just ask upfront, is there’s a lot of moving parts as we go into next year. I know you’re not guiding the 26th, but maybe any early thoughts, broad strokes around kind of where you think the orthobiologics business can grow when we strip out some of the other pieces that may be in flux. Thanks for taking the question.

Sean Browne, President and Chief Executive Officer, Xtant Medical: Sure. Okay. I’ll start off with the profitability question. Not the profitability question, the sales question. We’ve got the profitability. Last year, really in the second half of the year, we started making decisions on how do we conserve cash because we knew that we were going to have a lot of revenue coming in from the Q-Codes. We knew that we were going to have actually a very good year just operationally. In the fourth quarter of last year, we dramatically cut back the business overall. You can see it in our OpEx expense with the idea of being profitable. As part of that, we reduced a fair number of our commercial, not necessarily overly highly performing assets. Over the course of the last really quarter, we’ve now been replacing a lot of those spots in areas that make more sense.

Just to give you the scale to which we’re doing, we had roughly four reps that were selling the Xtant-branded products today. We’ve upped that, and by the end of the year, we’ll be at eight. We’ll double that. Again, in 2026, we expect to add probably four more. This is a fixable problem, or not a problem, but a fixable opportunity for us. I feel really good about where we’re going and even what I’m seeing from just having those new assets out in the field already. It is something that was somewhat predictive or predictable when we made those decisions last year and in the beginning of this year.

To give you some guidance with respect to 2026, as you mentioned, we are not going to be giving full guidance until really the year completes because there is a lot going on, a lot of good things. If I were to give you some general guidance, we do expect still to be in the low double digits with respect to our overall orthobiologics growth. As for the hardware, we are still working through some things right now, but I would still say that really that is what we can expect to see in 2026.

Scott Niels, Chief Financial Officer, Xtant Medical: No. That’s very helpful. Even just the broad strokes, I think, give us a sense of what you can do. Look, NAS is coming up, what, next week or this week, I should say.

Sean Browne, President and Chief Executive Officer, Xtant Medical: This Friday.

Scott Niels, Chief Financial Officer, Xtant Medical: Yeah, this Friday. Anything you want to highlight for people, for NAS, or anything that you’d say is worth checking out at the booth?

Sean Browne, President and Chief Executive Officer, Xtant Medical: Yeah. Thanks for asking. Thanks for the setup. Yes. Three things. First of all, our growth factor product is brand new. It’s outstanding. We’re replacing another growth factor product we were selling previously that someone else was making for us. This is our own product. We feel really good about it. We’ve done a great job of keeping the business that we once had, and we’re now starting to grow. That’s absolutely something people should check out. Second of all, we’ve now created a new advanced DBM called Trivium, which is really a terrific product that we would encourage our surgeons and distributors to look at. Not only is the growth factor count and just basically the overall characterization of the product outstanding, but the handling is even better.

The third thing is what we just rolled out, this CollagenX product, which literally can be used in almost every procedure and even procedures outside spine. Those would be three big things that we’re feeling really, really good about. The fact that the entire portfolio of our product line are now things that we make. We have a hand in. We control the supply chain, but also just in general, we just think we make really great products. Please stop by, and we’d love to give you a rundown of our really exciting portfolio.

Scott Niels, Chief Financial Officer, Xtant Medical: Thanks, Sean.

Sean Browne, President and Chief Executive Officer, Xtant Medical: Thank you, Ryan.

Conference Operator: Thank you very much. Our next question is coming from Chase Nickebucker of Craig-Hallum. Chase, your line is live.

Chase Nickebucker, Analyst, Craig-Hallum: Good morning. Thanks for taking the questions. Sean, maybe just to start, if you could just help me kind of dive a little bit deeper into that 3% year-over-year growth in orthobiologics, just as far as what supported growth in the quarter on a year-over-year basis, what detracted from it on a kind of product-specific kind of basis, if we can riff on that for a second.

Sean Browne, President and Chief Executive Officer, Xtant Medical: Sure. Absolutely. The actually was 4% growth year-over-year, which we had for our, and again, the areas that we’re still continuing to grow, grow nicely, continue to be our stem cell business. Again, the growth factor business is basically we’re holding serve in that, which is good because, again, we released a brand new product line. The amnio product line continues to be a nice product line, product growth area for us. We realize there’s going to be some changes with respect to the wound care world, but some of and a good chunk of some of the growth that we’ve also seen is in the surgical side, which should not change. Those would be a couple of the areas that I would say that really helped.

What hurt us this past quarter was maybe some of our old line demineralized bone products, and that’s why the addition of things like FiberX and Trivium, these higher-end, much, much better, much higher, not only from a handling perspective, but from a production perspective, and from, again, a growth factor characterization side of things, it is just outstanding products. We really hope and we really see that those things will be helping offset maybe some of the slide that’s been taking place from those old, still very good product lines. You realize that OsteoSelect, OsteoSponge, and 3Demin, I think OsteoSelect started, oh, no, OsteoSponge started in, what, 2008. OsteoSelect started in 2010, and I think 3Demin was 2013, 2013.

These are some old products that we’re now finding upgrades to that we just believe that we’ve really knocked it out of the park with some of the new things. They’re just starting to get traction, those new products. As a matter of fact, if you look at the Trivium product, it had one of its best months yet just recently. We’re really, really excited about where that’s going to take us.

Chase Nickebucker, Analyst, Craig-Hallum: Just maybe on the kind of legacy DBM side, was it mainly kind of white label or direct channel that?

Sean Browne, President and Chief Executive Officer, Xtant Medical: Definitely more direct channel. Yeah, definitely more direct channel. As I mentioned, when we pulled those resources out of the field, or at least eliminated them and really kind of reshuffling them now, it hurt us, I’m not going to lie. It is something that, but we knew what we were going into. Those were, again, probably sub-optimized assets when we did it. That is part of the reason why we pulled it out and said, "All right, profitability is the most important thing we’re going to do right now." We feel we can hold serve for most of what we have for our business. With a growing orthobiologic portfolio, we really feel like, "Okay, we might come across some rocky waters," which we have. Now, over the course of really the summer, we started adding back those resources in more strategically important areas.

As I mentioned, we’re going to continue to add more in 2026.

Chase Nickebucker, Analyst, Craig-Hallum: Got it. Maybe just on the amnio side, the changes that were announced in the final PFS, maybe just any thoughts as far as how it impacts your business as we take an eye into 2026. Just last one for me, Sean, as I think about CollagenX, probably a bigger market for similar products than people realize. Just kind of speak to your plans for that, even outside of spine, as far as how do you plan to distribute that product into what is a fairly large market for those particulates.

Sean Browne, President and Chief Executive Officer, Xtant Medical: Yeah. Let’s start with amnio. We manufacture amnio. Most of the people who sell the amnio care products today are not manufacturers. As a matter of fact, they need a fairly high price in order to be able to make real money. We, on the other side, are the very low end of the value creation. When you think about what it costs for us to make something, it’s quite low. When the price went to $127 per sq cm, it’s a very good, it’s actually a very good price for us as somebody who can actually serve the wound care, or I should say the acute care market.

If you recall, and if you see what’s happened in that world, this reimbursement opened the door for real movement from the out-of-hospital or the acute care or the non-acute world into the acute, or at least the outpatient clinics tied to the hospitals. We feel that we can do really well with the hospital contracts we have. There are many distributors out there today who do not have the kind of hospital contracting we do, and they need it. We think that there is an opportunity there. We will see what happens. I mean, this is something that we are just getting our arms around right now, speaking to various people, making sure our contracting is tight, but we, again, have a very, very robust contract portfolio. It is something we are trying to leverage as we speak. That is the amnio side.

Secondarily, when you think about the collagen-based products, one of the things that we acquired through the Surgiline acquisition was a product called Nanos. The basis of Nanos was an even more interesting product called E-Matrix. That E-Matrix was a collagen-based product that had extraordinary clinical data behind it. Actually, as the product was originally created, it was created as a wound care product. As a matter of fact, it was going through its own PMA, and the company essentially was running out of money and said, "Okay, let’s create something that we can start generating money from." They created Nanos, which was taking E-Matrix and then putting in hydroxyapatite with it. It became a product that was ultimately purchased by one of the predecessor companies, Surgiline. We acquired E-Matrix, which in itself is its own collagen-based product.

We see that as a really terrific platform for us moving forward because there’s a number of other areas we think that we can touch with it. There’s more to follow on that, but it’s a platform technology that we’re really, really excited about. We’ve got some FDA work that we need to do, but we’re really pretty pumped about where that’s leading. Hopefully that answered your question there, Chase.

Chase Nickebucker, Analyst, Craig-Hallum: Yeah. Thanks, Sean. Appreciate the questions, guys.

Conference Operator: Thank you very much. We appear to have reached the end of our question and answer session, and therefore, we have reached the end of the conference. Thank you very much. This does conclude today’s conference, and you may disconnect your phone lines at this time. We thank you for your participation.

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