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SI-BONE (SIBN) Q2 FY26 earnings call: guidance and Q&A

Earnings call· Jun 2026 (Q2 FY26)· Health Care· Aug 3, 2026

Source: earnings call transcript

Executive summary

SI-BONE, Inc. Q2 FY26 — Strong Revenue Growth and Profitability Improvement Driven by Broad-Based Demand and New Product Pipeline

SI-BONE delivered robust Q2 FY26 results, driven by broad-based procedural demand and strong physician engagement, leading to significant revenue growth and improved profitability. The company is strategically investing in R&D and commercial capacity ahead of multiple product launches, including a third breakthrough device, and anticipates further tailwinds from favorable reimbursement changes for Granite and SI joint procedures.

Highlights

5

  • Worldwide revenue grew 15.2% to $56 million.

  • Adjusted EBITDA improved 178% to $2.8 million, representing a 5.1% margin.

  • U.S. procedure volume increased nearly 15%, with double-digit growth across all modalities.

  • 1,715 unique physicians performed at least one procedure, an increase of approximately 19% year-over-year.

  • Ended the quarter with $145.9 million in cash and equivalents, an increase of $1.3 million sequentially, and positive cash flow from operations.

Concerns

3

  • Net loss narrowed to $4.1 million, or $0.09 per diluted share.

  • Anticipated higher than normal cash flow variability in Q3/Q4 due to new HQ build-out and surgical capacity investments.

  • Full-year revenue guidance midpoint raised by only $500,000 despite Q2 outperformance, implying back-half deceleration.

Guidance & targets

CategoryTargetConfidence
Worldwide revenue
$231M-$233M
high materiality
High
Full-year gross margin
79%
medium materiality
High
Territory Managers count
Nearly 100
medium materiality
High
Third breakthrough device launch
Phased commercial launch
high materiality
High
New product development
Two additional solutions to progress toward design freeze
medium materiality
Medium
NTAP for third breakthrough device
Plan to apply, if approved, effective October 1, 2027
medium materiality
Medium

Segment performance

SegmentRevenueYoYQoQMargin
Worldwide
Strong top-line growth yielded meaningful operating leverage.
$56M15.2%——
U.S.
Strongest second quarter sequential increase in years, dispelling industry concerns regarding the payer environment.
Procedure volume growth: nearly 15% YoYProcedure volume growth: double-digit across all modalitiesProcedure volume growth (2-year stack basis): nearly 20%Sequential procedure volume growth: approximately 9%
$53.2M14.7%——
International
Led by continued demand for expanded portfolio, specifically TORQ and TNT. Evaluating opportunities to introduce more products and enter new geographies.
$2.8M25.9%——

Product announcements

ProductTypeDetails
Third breakthrough device (non-pelvic solution)launch

Deals & partnerships

Smith & Nephew Commercial partnership for orthopedic trauma surgeons, focusing on TORQ and TNT products for sacral insufficiency fractures.

Coordinating joint field activity, training their field organization, expanding surgical capacity (trays, inventory). Leveraging Smith & Nephew's depth of relationship with orthopedic trauma surgeons. Goal is to keep SI-BONE's sales force focused on spine and interventional, while Smith & Nephew covers trauma.

Risks & headwinds

Seasonality in Q3 revenue Q3 FY26

Implies 1-2% sequential decline in revenue.

Mitigation:Strong physician base, expanded sales force, opportunity with interventional products (Intra family) and TNT.

Cash flow variability due to investments Q3 and Q4 FY26

Higher than normal cash flow variability.

Mitigation:Driven by timing of payments for new HQ build-out and surgical capacity investments, with tenant improvement allowance reimbursement to follow. These are temporary, disciplined investments.

Potential for low single-digit ASP degradation Full-year guidance assumption

Low single-digit ASP degradation.

Mitigation:Due to ramp in interventional or trauma cases which use fewer implants. New product is complementary and could be used in same cases as Granite, potentially offsetting this.

What to watch in Q3 FY26

Third breakthrough device launch ramp

Q4 FY26
Current 510(k) submitted in June, phased launch expected Q4 FY26.
Target Initial sales and adoption pace.

Why it matters

This is the company's first non-pelvic solution, targeting a large unmet need in spine, and is expected to be a significant growth driver.

Subject to the 510(k) clearance, we remain on track to begin a phased commercial launch in the fourth quarter, perhaps as early as October.

Find out whether SIBN delivers this. Inve re-checks your case every morning.

Q&A highlights

Why is the back-half guidance increase so modest ($500k) despite Q2 outperformance, implying deceleration?

Management is being thoughtful, acknowledging Q3 seasonality, and wants to grow into catalysts like the third breakthrough device launch and new DRGs. There could be upside if catalysts play out better than anticipated.

“So we actually feel pretty good about the setup and there could be room for upside as those catalysts play out better than anticipated.”

asked by Matthew O'Brien · answered by Anshul Maheshwari

2 min read 6 chapters

Detailed narrative

Innovation and Market Development

SI-BONE continues to expand its portfolio beyond the sacroiliac joint, focusing on high-risk patients with compromised bones. The company submitted a 510(k) application for its third breakthrough device in June, targeting a recognized failure point in complex spine procedures, with a phased commercial launch expected in Q4. Several other development programs are underway, with two additional solutions targeting design freeze later this year for potential commercialization within 18 months.

Reimbursement Tailwinds

Recent CMS proposals include an increase of approximately $1,000 for SI joint procedures (to nearly $16,000) and OBL reimbursement of over $20,000 for CPT code 27279. New DRGs for complex spinal fusion procedures, including those incorporating Granite, could increase average hospital payments by up to $50,000 per procedure, effective October 1st. A grandfather clause for breakthrough devices is also expected to facilitate NTAP access.

Physician Engagement and Utilization

The company saw a 19% increase in unique physicians performing at least one procedure, reaching 1,715, exceeding full-year 2023 numbers. Physicians performing more than one procedure type increased by 15%, and active physicians averaged 3x the case volume of new physicians. This broad-based engagement and increasing utilization are expected to drive sustained procedure and revenue growth.

Commercial Execution and Capacity Expansion

SI-BONE ended the quarter with 93 quota-carrying territory managers, supported by over 400 agents and junior representatives. Trailing 12-month revenue per territory was approximately $2.2 million. The company plans to reach nearly 100 territories by year-end 2026, a deliberate expansion to support upcoming product launches and strengthen physician relationships.

Operational Excellence and Profitability

Gross margin remained strong at 79.5%. Operating expenses increased 7.7%, substantially below revenue growth, contributing to a 178% improvement in adjusted EBITDA to $2.8 million. The company is intentionally increasing R&D investment in H2 to advance longer-term programs while remaining committed to annual operating leverage and profitability expansion goals.

Smith & Nephew Partnership Progress

The commercial partnership with Smith & Nephew is progressing well, with cases underway and increasing physician and field engagement. The collaboration focuses on orthopedic trauma surgeons, leveraging Smith & Nephew's relationships to expand the reach of products like TORQ and TNT for sacral insufficiency fractures, with momentum expected to build throughout the rest of 2026.

Summary of the company's earnings call; see how call summaries are prepared. Not investment advice.