Skip to content
    NTRA
    Earnings call· Dec 2025(Q4 FY25)

    Natera, Inc. NTRA

    Feb 26, 2026 Source

    Executive summary

    Natera Q4 FY25 — Record Revenue and MRD Growth, Strong 2026 Guidance

    Natera delivered a transformative Q4 FY25, marked by record revenue and MRD clinical unit growth, alongside significant gross margin expansion and strong cash flow generation. The company initiated a robust 2026 guide, projecting continued top-line growth and further margin improvement, while strategically investing in R&D and maintaining SG&A stability. Key product launches and clinical data readouts are expected to fuel future growth.

    Highlights

    5

    • Processed 924,000 tests in Q4 FY25, including 225,000 MRD clinical units (56% growth YoY).

    • Generated $666 million in Q4 FY25 revenue, representing 40% growth over Q4 2024.

    • Achieved a record gross margin of 66.9% in Q4 FY25 (63.7% organic).

    • Signatera ASPs increased to $1,225 in Q4 FY25.

    • Generated over $107 million in cash flow in FY25.

    Concerns

    1

    • Initial 2026 gross margin guidance (63-65%) reflects caution due to Q4 tailwinds not repeating and new products not yet reimbursed.

    Guidance & targets

    11
    CategoryTargetConfidence
    Revenue
    $2.62B - $2.7B
    high materiality
    High
    Gross Margins
    63% - 65%
    high materiality
    Medium
    Cash Flow
    strong cash flow year
    medium materiality
    High
    SG&A
    roughly stable
    medium materiality
    High
    Signatera ASP growth
    another $30 or so
    medium materiality
    High
    Organ Health product growth
    another strong year
    medium materiality
    High
    Women's Health volume growth
    mid-single-digit range
    low materiality
    High
    Women's Health revenue growth
    better than mid-single-digit
    low materiality
    High
    Signatera and Prospera sequential growth
    grow sequentially quarter-over-quarter
    medium materiality
    High
    Japan launch
    later this year
    medium materiality
    High
    Japan revenue impact
    very solid impact on our revenue
    medium materiality
    High

    Segment performance

    3
    SegmentRevenueYoYQoQMargin
    Oncology (Signatera)
    Q4 represented yet another record growth quarter for MRD clinical units. More than 50% of oncologists in the U.S. ordered a Signatera test in Q4. Off to a great start in Q1 2026.
    MRD clinical units processed: 225,000MRD clinical unit growth YoY: 56%Signatera ASP: $1,225
    		————
    Women's Health
    Significant interest in the Fetal Focus test, fueling meaningful growth in new OB/GYN and MFM accounts. Expects mid-single-digit volume growth in 2026, with revenue growth potentially higher due to pricing gains.
    Fetal Focus: 21-gene offering launched
    		————
    Organ Health (Prospera)
    Continued investment in improving clinical utility. Strong clinical data has fueled meaningful share gains in thoracic as well as renal transplantation. Expects another strong year of growth in 2026.
    ACES-EMB trial enrollment: Completed (heart transplant)Ohio State University study: reduced 9-month surveillance biopsies in ~75% of lung transplant patients
    		————

    Operational metrics

    25
    Revenue
    $666M40% YoY growth
    Q4 FY25

    approximately $6 million ahead of preannounced

    Gross Margin
    66.9%record
    Q4 FY25

    3% benefit from revenue true-ups; 240 basis points organic step-up compared to Q3

    Cash and Securities
    over $1B
    Q4 FY25 end

    balance sheet remains pristine

    Operating Losses
    significantly narrowedvs last year
    Q4 FY25

    even as we significantly stepped up our investments in OpEx

    Net Income
    generated net income
    Q4 FY25

    helped along by a one-timer, which was a below-the-line deferred tax item related to the Foresight acquisition

    Revenue True-ups
    $60M
    Q4 FY25

    consistent with preannounced as cash collections continue to accelerate

    Days Sales Outstanding (DSOs)
    47 daysvs 68 days in Q4 2024
    Q4 FY25

    posted another record for DSOs

    Operating Expenses (OpEx) growth
    9.5%vs ~25% pro forma revenue growth
    FY26

    at the midpoint, just a bit better than what we previewed on the Q3 call

    SG&A
    roughly stable
    FY26

    while we make targeted investments in R&D

    R&D Investment
    —
    FY26

    substantial investment in DEFINE trial for early cancer detection in colorectal cancer and the investments we are making in large clinical trials and technology development focused on MRD

    Oncologists ordering Signatera
    more than 50%
    Q4 FY25

    estimated based on internal data

    Latitude MRD performance (Hazard Ratio post surgery)
    10
    Q4 FY25

    Latitude MRD positivity was highly prognostic for recurrence

    Latitude MRD performance (Hazard Ratio post-treatment surveillance)
    31.9
    Q4 FY25

    Latitude MRD positivity was highly prognostic for recurrence

    Latitude MRD performance (longitudinal sensitivity)
    84%
    Q4 FY25

    from GALAXY study

    Latitude MRD performance (sample level specificity)
    97%
    Q4 FY25

    from GALAXY study

    Latitude MRD performance (median lead time ahead of imaging)
    4.6 months
    Q4 FY25

    from GALAXY study

    Phased Variants LOD95
    3 parts per 10 million
    Q4 FY25

    analytically, detection below 1 part per 10 million

    SYNERGY trial (patients de-escalated chemotherapy)
    74%
    Q4 FY25

    at least once

    SYNERGY trial (median chemotherapy cycles delivered)
    2 cyclesvs typical 6 cycles
    Q4 FY25

    meaningful reduction in chemotherapy

    SYNERGY trial (objective response rate)
    63%vs 19-36% in original registrational trial
    Q4 FY25

    really strong

    SYNERGY trial (Grade 3+ toxicity rate)
    48%
    Q4 FY25

    clear improvement over historical precedents

    Fetal Focus sensitivity
    96%
    Q4 FY25

    test performance is robust

    Fetal Focus specificity
    98%
    Q4 FY25

    test performance is robust

    ACES-EMB trial enrollment
    over 300 patients
    Q4 FY25

    across 17 transplant centers in the U.S.

    Lung transplant biopsies avoided
    ~75%
    Q4 FY25

    clinicians elected to forgo the 9-month surveillance biopsy based on low-risk Prospera results

    Product announcements

    4
    ProductTypeDetails
    Fetal Focus single-gene NIPTlaunch
    Signatera genome versionlaunch
    Latitude Tissue-Free MRD testlaunch
    Phased Variants technology (integrated into Signatera)launch

    Deals & partnerships

    1
    Foresight DiagnosticsAcquired phased variant technology

    Natera closed the acquisition of Foresight Diagnostics in December 2025, immediately integrating phased variants into the Signatera platform to enhance MRD performance.

    Risks & headwinds

    1
    New products not yet reimbursed2026

    some of the drivers of the Q4 improvement may not repeat every quarter. And two, we've got some products launching that aren't yet reimbursed

    Mitigation: The coverage road map that John described, I can certainly see a path to margin outperformance this year.

    What to watch in Q1 FY26

    5

    Signatera sequential unit growth

    Q1 FY26
    Current~20,000 units (trailing 4-quarter average)
    TargetContinued growth above 20,000 units

    Why it matters

    Indicates underlying momentum and compounding effect of repeat volumes per patient, crucial for overall business growth.

    I think that's a decent bar for evaluating Q1. And then as you continue to grow, the reason why I like that approach is that it does update itself and it kind of gives effect to the compounding effect that we have in the business, given that it's a repeat volumes per patient.

    Q&A highlights

    6

    How do Medicare ADLT surveillance and adjuvant bundle rate changes impact Signatera ASPs and the projected $30 annual growth?

    The Medicare ADLT and bundle rate changes roughly net each other out. The projected $30 ASP growth is primarily driven by broadening reimbursement for covered services and progress in biomarker states, with additional MolDx coverage decisions representing potential upside not yet embedded in the guide.

    “the changes on the ADLT rate and on the bundle roughly net each other out, given kind of the mix that we've had in terms of recurrence and bundles over the past year.”

    asked by Catherine Schulte · answered by Mike Brophy

    2 min read6 chapters

    Detailed Narrative

    01

    Q4 FY25 Performance Highlights

    Natera reported a strong Q4 FY25, processing approximately 924,000 tests, including a record 225,000 MRD clinical units, representing 56% year-over-year growth. Revenue reached $666 million, a 40% increase from Q4 2024, exceeding pre-announced figures. The company achieved a record gross margin of 66.9% (63.7% organic) and generated over $107 million in cash flow for FY25.

    02

    2026 Financial Outlook

    For 2026, Natera initiated guidance projecting revenues between $2.62 billion and $2.7 billion, and gross margins of 63% to 65%. The company expects to maintain SG&A stable while increasing R&D investments, aiming for another strong cash flow year. The revenue guide implies approximately 25% growth over 2025, excluding true-up📎s.

    03

    Product Portfolio Expansion

    Natera significantly expanded its MRD product portfolio with the launch of the genome version of Signatera and the Latitude MRD test, which complements Signatera by enabling MRD assessment without tumor tissue. The company also launched the 21-gene Fetal Focus single-gene NIPT test, which received an oral plenary presentation at the Society of Maternal-Fetal Medicine Conference.

    04

    Oncology Data and Innovation

    The company highlighted strong momentum in bladder cancer with data reinforcing Signatera's role in risk stratification and bladder preservation strategies. The SYNERGY trial in head and neck cancer demonstrated Signatera's utility as a treatment navigation tool, enabling chemotherapy de-escalation while improving response rates. The integration of phased variants technology from Foresight Diagnostics is expected to enhance Signatera's sensitivity to unprecedented🌐 levels, below one fragment of tumor DNA in 10 million normal copies.

    05

    Women's and Organ Health Progress

    In women's health, Fetal Focus, powered by LinkedSNP technology, addresses unmet clinical needs for inherited conditions. In organ health, the ACES-EMB trial for heart transplant surveillance completed enrollment, with results expected in mid-2027. New data in lung transplant showed Prospera-guided monitoring can reduce unnecessary biopsies, driving engagement in thoracic transplantation.

    06

    Reimbursement and Operational Efficiency

    Natera submitted Latitude to MolDx for colorectal cancer reimbursement and has multiple Signatera submissions under review for broader indications. The company is also pursuing broader Medicare reimbursement for Signatera and seeing commercial payer adoption. AI-enabled workflows are being deployed to improve reimbursement and reduce COGS.

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