LivaNova (LIVN) Q4 FY25 earnings call: guidance and Q&A

How are HLM vs. oxygenator growth components expected in FY26, and can you quantify the Q4 tender shift?

Essenz upgrades will drive double-digit HLM growth, with continued market share gains in consumables. The Q4 tender shift was immaterial and will be fully recaptured in Q1 2026, with no material impact on the full-year guide.

“It wasn't -- it wasn't super material in terms of the shift. So it's fully incorporated into our full year guide.”

asked by Adam Maeder · answered by Alex Shvartsburg

Does the higher FY26 epilepsy guidance reflect incremental tailwinds from elevated reimbursement, and how should we think about pricing vs. utilization benefits?

The significant Medicare reimbursement increase and positive core VNS study results are lasting growth levers. Price will be a short-term contributor, but increased penetration takes time. Two-thirds of US epilepsy revenue comes from replacement implants, so new patient volume has less immediate impact.

“So we're changing physician behavior and reactivating closed accounts, and that just doesn't happen overnight. So we're being kind of prudent at this point given those assumptions.”

asked by David Rescott · answered by Alex Shvartsburg

Is there any exposure or risk of denials in the Medicare patient population due to the WISeR program?

LivaNova has seen virtually no impact or denials in tracked cohorts. A significant portion of Medicare patients are under Medicare Advantage, which already requires prior authorization, so nothing changes dramatically for the business.

“David, in the cohorts that we've been tracking, we haven't seen any denials, so virtually no impact.”

asked by David Rescott · answered by Alex Shvartsburg

Where did the Q4 HLM tender timing slip, and what is the fresh perspective on the Essenz opportunity in China?

The Q4 shift was immaterial and will be fully captured in Q1/Q2. The China launch is going as planned; LivaNova is the market leader with over 80% win rate. 2026 will be the first year of significant impact for Essenz in China, driving the target of 80% Essenz penetration for new HLM placements by year-end.

“And as a reminder, Essenz in terms of percent placements of all HLM is going from approximately 55% last year to approximately 80% this year, and a big driver of this will be coming from China.”

asked by Michael Polark · answered by Vladimir Makatsaria

How does CMS removing HGNS procedures from the VNS code impact LivaNova, and what are the trade-offs for VNS vs. future HGNS opportunities?

CMS stated the VNS code should be separate from HGNS/OSA. LivaNova will work with medical societies for appropriate HGNS codes and expects to use prevailing codes at launch, seeing no risk. The company continues to advocate for Level 6 APC classification for VNS Therapy.

“And consistent with the recent statement by CMS, we believe that the code for VNS therapy for epilepsy should be separate and not shared with reimbursement codes for HGNS or OSA.”

asked by Brett Fishbin · answered by Ahmet Tezel

If favorable CMS coverage is achieved for DTD, should we expect Level 6 or Level 5 coding, and what would be the payout?

DTD would use the same code as VNS Therapy. LivaNova is continuously advocating and actively pursuing a Level 6 APC classification for VNS Therapy, so if epilepsy moves there, depression would follow. It's too early to comment on ASPs.

“So we anticipate that depression would be the same code as VNS Therapy. So where -- whatever the VNS Therapy code is today, it will be the same code.”

asked by Anthony Petrone · answered by Ahmet Tezel

If current HGNS reimbursement status doesn't change, will it limit the success of LivaNova's OSA launch in 2027?

LivaNova is comfortable with the current coding and believes it's still a very meaningful growth opportunity. The company's excitement for OSA, with its differentiated technology and clinical outcomes, remains unchanged.

“We're very comfortable with the current coding that CMS guided towards. It will still be very meaningful growth opportunity for us. So we're -- our excitement around the OSA space hasn't changed at all.”

asked by Michael Matson · answered by Ahmet Tezel