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    NRXS
    Earnings call· Jun 2026(Q2 FY26)

    Neuraxis Q2 FY26 earnings call NRXS

    Aug 11, 2026 Source

    Executive summary

    NeurAxis Q2 FY26 — Strong Revenue Growth Driven by CPT Code and Payer Progress

    NeurAxis reported strong Q2 FY26 revenue growth, driven by the new Category 1 CPT code and a favorable shift to full reimbursement payers, which also boosted gross margins. The company made significant progress with two large commercial payers and is aggressively expanding into VA Medical Centers. While operating expenses and cash burn are expected to increase in the near term to capitalize on market opportunities, the focus remains on expanding payer coverage and executing intensely in covered markets to drive future revenue and profitability.

    Highlights

    5
    • Revenue increased 116% year-over-year to $1.928 million in Q2 FY26.

    • IB-Stim average selling price rose 30% year-to-date to $1,003.

    • Gross margin expanded 230 basis points to 85.9% in Q2 FY26.

    • Significant progress made with two large commercial payers for additional coverage.

    • VA Medical Centers identified as a meaningful growth platform, with 10 1099 reps to be in the field by September 15.

    Concerns

    4
    • Operating loss increased 24% year-over-year to $2.1 million in Q2 FY26 due to higher operating expenses.

    • Cash burn is expected to increase in the second half of FY26 due to aggressive commercial hiring and R&D investments.

    • Many states have not yet included CPT code 64567 on their 2026 Medicaid fee schedules, hindering access.

    • Hospitals require 70% payer coverage to fully commit to aggressive IB-Stim programs, a threshold not yet broadly met.

    Guidance & targets

    3
    CategoryTargetConfidence
    Additional payer coverage
    Additional coverage
    high materiality
    Medium
    Cash burn
    Increase
    medium materiality
    High
    Covered lives
    Over 200 million
    high materiality
    High

    Operational metrics

    59
    Revenue
    $1.928Mup 116% YoY
    Q2 FY26

    Compared to $894,000 in Q2 FY25.

    Revenue
    $894,000
    Q2 FY25

    Prior year comparable revenue.

    Revenue
    $3.5Mup 98% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $1.8 million in YTD FY25.

    Revenue
    $1.8M
    YTD FY25

    Prior year comparable YTD revenue.

    IB-Stim unit deliveries
    60%YoY
    Q2 FY26

    Increase for the 3 months ended June 30, 2026.

    IB-Stim unit deliveries
    48%YoY
    YTD FY26

    Increase for the 6 months ended June 30, 2026.

    IB-Stim average selling price
    $1,003up 30% YoY
    YTD FY26

    Compared to $772 in YTD FY25, driven by mix shift to full reimbursement payers.

    IB-Stim average selling price
    $772
    YTD FY25

    Prior year comparable YTD average selling price.

    IB-Stim average selling price
    $992up 28% YoY
    Q2 FY26

    Compared to $778 per device in Q2 FY25.

    IB-Stim average selling price
    $778
    Q2 FY25

    Prior year comparable Q2 average selling price.

    Internal prior authorization approval percentage
    31%vs 12% YTD FY25
    YTD FY26

    Year-to-date approval percentage.

    Internal prior authorization approval percentage
    12%
    YTD FY25

    Prior year comparable YTD approval percentage.

    Number of ordering accounts
    88up 16% YoY
    YTD FY26

    Year-to-date, compared to 76 at the same point last year.

    Number of ordering accounts
    76
    YTD FY25

    Prior year comparable YTD ordering accounts.

    Revenue per ordering IB-Stim account
    $40,000up 68% YoY
    YTD FY26

    Year-to-date through June 30, compared to $24,000 in YTD FY25.

    Revenue per ordering IB-Stim account
    $24,000
    YTD FY25

    Prior year comparable YTD revenue per ordering account.

    Gross margin
    85.9%up 230 bps YoY
    Q2 FY26

    Compared to 83.6% in Q2 FY25, due to mix shift from discounted financial assistance to full reimbursement payers.

    Gross margin
    83.6%
    Q2 FY25

    Prior year comparable Q2 gross margin.

    Gross margin
    86.1%up 210 bps YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to 84% in YTD FY25.

    Gross margin
    84%
    YTD FY25

    Prior year comparable YTD gross margin.

    Total operating expenses
    $3.8Mup 53% YoY
    Q2 FY26

    Compared to $2.5 million in Q2 FY25.

    Total operating expenses
    $2.5M
    Q2 FY25

    Prior year comparable Q2 total operating expenses.

    Total operating expenses
    $6.9Mup 25% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $5.5 million in YTD FY25.

    Total operating expenses
    $5.5M
    YTD FY25

    Prior year comparable YTD total operating expenses.

    Selling expenses
    $862,000up 61% YoY
    Q2 FY26

    Compared to $534,000 in Q2 FY25, due to commissions, additional sales reps, marketing personnel, and travel.

    Selling expenses
    $534,000
    Q2 FY25

    Prior year comparable Q2 selling expenses.

    Selling expenses
    $1.7Mup 63% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $1 million in YTD FY25.

    Selling expenses
    $1M
    YTD FY25

    Prior year comparable YTD selling expenses.

    Research and development expenses
    $274,000up 138% YoY
    Q2 FY26

    Compared to $115,000 in Q2 FY25, due to additional clinical research studies.

    Research and development expenses
    $115,000
    Q2 FY25

    Prior year comparable Q2 R&D expenses.

    Research and development expenses
    $374,000up 68% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $222,000 in YTD FY25.

    Research and development expenses
    $222,000
    YTD FY25

    Prior year comparable YTD R&D expenses.

    General and administrative expenses
    $2.6Mup 46% YoY
    Q2 FY26

    Compared to $1.8 million in Q2 FY25, due to incremental clinical headcount, advisory costs, stock compensation, benefit costs, and incentive plan costs.

    General and administrative expenses
    $1.8M
    Q2 FY25

    Prior year comparable Q2 G&A expenses.

    General and administrative expenses
    $4.9Mup 14% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $4.3 million in YTD FY25.

    General and administrative expenses
    $4.3M
    YTD FY25

    Prior year comparable YTD G&A expenses.

    Operating loss
    $2.1Mup 24% YoY
    Q2 FY26

    Compared to $1.7 million loss in Q2 FY25.

    Operating loss
    $1.7M
    Q2 FY25

    Prior year comparable Q2 operating loss.

    Operating loss
    $3.9Mdown 4% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $4 million in YTD FY25.

    Operating loss
    $4M
    YTD FY25

    Prior year comparable YTD operating loss.

    Net loss
    $2.1Mup 23% YoY
    Q2 FY26

    Compared to $1.7 million in Q2 FY25.

    Net loss
    $1.7M
    Q2 FY25

    Prior year comparable Q2 net loss.

    Net loss
    $3.8Mdown 3% YoY
    YTD FY26

    For the 6 months ended June 30, 2026, compared to $4 million in YTD FY25.

    Net loss
    $4M
    YTD FY25

    Prior year comparable YTD net loss.

    EPS
    -$0.19improved from -$0.22
    Q2 FY26

    Compared to -$0.22 in Q2 FY25.

    EPS
    -$0.22
    Q2 FY25

    Prior year comparable Q2 EPS.

    EPS
    -$0.37improved from -$0.56
    YTD FY26

    For the 6 months ended June 30, 2026, compared to -$0.56 in YTD FY25.

    EPS
    -$0.56
    YTD FY25

    Prior year comparable YTD EPS.

    Cash on hand
    $8.3M
    as of June 30, 2026

    Liquidity position at quarter end.

    Free cash outflow
    $1M
    Q2 FY26

    For the 3 months ended June 30, 2026.

    Free cash outflow
    $2.3M
    YTD FY26

    For the 6 months ended June 30, 2026.

    Average quarterly burn rate
    $1.1Mvs $1.5M FY25
    YTD FY26

    Year-to-date average, significantly better than prior year.

    Average quarterly burn rate
    $1.5M
    YTD FY25

    Prior year comparable YTD average quarterly burn rate.

    Reclassified G&A to Selling expenses
    $392,000
    Q2 FY25

    Reclassified for 3 months ended June 30, 2025, to conform to current period presentation.

    Reclassified G&A to Selling expenses
    $758,000
    YTD FY25

    Reclassified for 6 months ended June 30, 2025, to conform to current period presentation.

    Reclassified G&A to R&D expenses
    $57,000
    Q2 FY25

    Reclassified for 3 months ended June 30, 2025, to conform to current period presentation.

    Reclassified G&A to R&D expenses
    $114,000
    YTD FY25

    Reclassified for 6 months ended June 30, 2025, to conform to current period presentation.

    Covered lives
    More than 100 million
    Current

    Current number of covered lives for PENFS.

    Hospital commitment threshold
    70%
    Current

    Percentage of payer coverage hospitals require to fully activate programs and allocate consistent clinic time.

    Industry KPIs

    6
    MetricValueDetails
    Pricing realized price$992USD
    Procedure volume growth60%%
    FCF conversion leverage guidanceIncrease
    Sales force commercial capacity build10reps
    Indicated addressable patient population3%%
    Pivotal trial clinical evidence milestonesProgressing

    Deals & partnerships

    1
    U.S. Department of Veterans AffairsFederal Supply Schedule contract for PENFS

    The VA health care system serves nearly 7 million active patients annually, with functional dyspepsia estimated to affect approximately 3% of that population. This contract provides a pathway not dependent on commercial payer coverage.

    Risks & headwinds

    5
    Lack of comprehensive insurance coverageOngoing

    Only treating a 'fraction of patients' despite strong demand; utilization is not optimized where one element (coverage, physician champion, operational capacity) is missing.

    Mitigation: Aggressive market access strategy, hiring a VP of Healthcare Economics and Policy, direct engagement with payers, and preparing commercial infrastructure to scale as additional coverage comes online.

    Medicaid fee schedule inclusion delaysOngoing

    CPT code 64567 not yet fully loaded in many states' 2026 fee schedules, hindering medically necessary coverage and delaying program launches.

    Mitigation: Payer outreach now includes state Medicaid fee schedules, focusing on implementation issues rather than clinical adoption.

    Hospital capacity issuesCurrent

    Patients in some of the best accounts are waiting for multiple months for care due to capacity issues.

    Mitigation: Hiring a Director or VP of Provider Economics to communicate economic and operational value to administrators and hospital stakeholders to gain more IB-Stim clinic time.

    Increased operating expenses and cash burnH2 FY26

    Total operating expenses increased 53% in Q2 FY26; cash burn expected to increase in H2 FY26.

    Mitigation: Strategic hiring of sales, marketing, and clinical personnel, and increased R&D expenditures are growth-related investments expected to drive future revenue growth and eventually offset the burn.

    Going concernUntil cash flow breakeven/profitability is reached.

    Still a factor.

    Mitigation: Continued focus on revenue growth and operating leverage to reduce cash burn, with significant reliance on securing additional insurance coverage to change the outlook.

    What to watch in Q3 FY26

    5

    Additional payer coverage

    H2 FY26 or early FY27
    CurrentSignificant progress with two large payers
    TargetAdditional coverage

    Why it matters

    Securing additional payer coverage is the single most important driver of scalable growth, unlocking significant revenue and enabling hospitals to fully commit to IB-Stim programs.

    We are cautiously optimistic💬 that these efforts will result in additional coverage in the second half of 2026 or early 2027.

    Q&A highlights

    6

    Can you provide more color on the progress with the two large payers and what drives your confidence? Also, how do you see sequential growth in the back half of the year – driven by new coverage or current market saturation?

    Confidence stems from direct conversations with payers who believe PENFS should be a covered service. Growth will come from aggressively saturating states with existing decent-to-good policy coverage and from additional payers writing new policy coverage, which will unlock significant revenue.

    My confidence comes from the fact that we've had direct conversations. I wouldn't be confident if we didn't have direct conversations with a payer who made comments or alluded to the fact that they believe this should -- they also believe this should be a covered service.

    asked by Chase Knickerbocker · answered by Brian Carrico

    2 min read6 chapters

    Detailed Narrative

    01

    CPT Code Impact & Strategy

    The Category 1 CPT code for PENFS, effective January 1, 2026, confirmed key drivers for adoption, leading to disciplined strategic decisions in Q2. The company's strategy is centered on securing remaining insurance coverage and maximizing execution in covered markets, positioning the organization to scale rapidly as new coverage comes online. This approach has moved the company from theory to evidence, providing a clear roadmap for addressing historical adoption barriers.

    02

    Payer Progress & Market Access

    NeurAxis reported significant progress with two large commercial payers, expressing cautious optimism for additional coverage in H2 2026 or early 2027. The market access strategy has been elevated to include direct engagement with commercial payers, inclusion in state Medicaid fee schedules, physician and KOL advocacy, and guidance from former payer executives. A new VP of Healthcare Economics and Policy is being hired to focus on upstream initiatives, while the VP of Market Access and Reimbursement will concentrate on downstream implementation and reimbursement pull-through.

    03

    Commercialization & Resource Deployment

    Commercial execution is now the primary driver of growth, with the organization aligning resources to markets and accounts demonstrating the strongest coverage, demand, and utilization potential. The company is prioritizing hospitals based on reimbursement, patient opportunity, and their ability to dedicate clinic capacity to IB-Stim. A disciplined approach avoids broad expansion into markets lacking sufficient payer coverage, instead focusing on in-depth penetration of select favorable markets to generate higher returns and predictable growth.

    04

    Team Expansion & Initiatives

    In Q2, NeurAxis strengthened its commercial team with new hires, including a full-time VP of Sales, VP of Marketing, a digital marketing expert, a medical science liaison, and a Director of Clinical Adoption. New initiatives include a targeted regional sales rep coverage model in key states, increased sales training rigor, and a focus on integrated health programs within pediatric GI. A 'strategic market initiative' will coordinate payer access, field execution, clinical education, and marketing efforts in targeted markets to create local intensity.

    05

    VA Opportunity

    The federal supply schedule contract with the U.S. Department of Veterans Affairs is showing early activity, with multiple VA facilities placing orders and reorders. The VA represents a second meaningful growth platform due to its large patient population (7 million active patients, 3% with functional dyspepsia), centralized purchasing, and independence from commercial payer coverage. The company plans to deploy 10 1099 territory reps by September 15 to expand this channel, with expectations for a strong revenue read by year-end.

    06

    Adult Functional Dyspepsia Program

    A large multisite randomized controlled trial evaluating IB-Stim in adult patients with functional dyspepsia is in its early stages. This study is designed to generate the necessary evidence to support future adult medical policy coverage. While this trial progresses, NeurAxis' near-term commercial focus remains strictly on children's hospitals and the VA, with minimal resources allocated to the adult study.

    AI-generated summary of the company’s earnings call. Not investment advice.