Neuronetics reported preliminary, unaudited fourth-quarter and full-year 2025 results showing material step-up in scale following its integration of Greenbrook clinics. Q4 revenue reached $41.8 million, up 86% year over year on an as-reported basis and 23% on an adjusted pro forma basis that assumes the Greenbrook acquisition at the start of 2024 and the closure of non-performing clinics. Full-year revenue was $149.2 million, up 99% as reported and 15% pro forma. The company generated positive operating cash flow of $0.9 million in Q4 and ended the year with $34.1 million in cash. Within the mix, NeuroStar systems revenue was $18.3 million in Q4, up 9% pro forma, with 49 systems shipped, while clinic revenue reached $23.5 million, up 37% pro forma. For the full year, NeuroStar revenue totaled $62.2 million, up 0.9% pro forma, and clinic revenue reached $87.0 million, up 28% pro forma.
The signal beneath the headline is a deliberate reweighting from a capital equipment story to a services-driven platform. Modest pro forma growth for systems alongside outsized clinic expansion suggests the growth engine has shifted to recurring patient care revenue, not new hardware placements. For an industry long accustomed to selling devices into fragmented psychiatric practices, a vertically integrated model that controls referral pathways, scheduling, and outcomes data may be the more durable route to scale. The strategic question is whether this integration can consistently convert volume into margin while maintaining payer alignment on utilization and medical necessity.
This pivot matters now because mental health demand remains elevated while access, adherence, and payer scrutiny are tightening simultaneously. For patients, the clinic footprint can compress wait times and standardize protocols across transcranial magnetic stimulation and adjunctive treatments such as esketamine, potentially improving continuity of care. For payers, a scaled network intensifies the urgency to validate real-world effectiveness, duration of response, and retreatment rates across a broader case mix, as utilization growth must be justified against total cost of care. For referring HCPs, a single-operator network simplifies navigation but raises expectations for measurable outcomes, transparent scheduling, and seamless data back to primary and specialty care.
Commercially, the calculus shifts from one-time capital sales to lifetime value per clinic and per patient. Same-clinic revenue growth, course completions, and utilization per chair become the metrics to watch, not just system shipments. Network optimization—evidenced by shuttering underperforming sites—signals a willingness to trade footprint for productivity, a discipline that device-centric peers and outpatient mental health roll-ups have struggled to impose at scale. For competitors in TMS hardware and behavioral health platforms, the playbook now includes evidence generation at the point of care, payer contracting sophistication, and tight operational KPIs, not only features and price.
Medical Affairs teams should view this as an RWE opportunity in a space where trial heterogeneity has often limited generalizability. A unified clinic and device infrastructure can standardize measurement-based care, capture longitudinal outcomes on comorbid anxiety and obsessive-compulsive disorder adjunct use, and support subgroup analyses that resonate with payers and guidelines. The challenge will be governance: consistent protocols, pragmatic endpoints, and integration of patient-reported outcomes without adding friction that undermines throughput.
As Neuronetics prepares to report detailed results in March, the leading indicators will be utilization intensity, same-clinic growth, and cash conversion, alongside any early signs of payer pushback or pathway tightening. If vertical integration can deliver both operating leverage and higher-quality outcomes data, mental health devices may increasingly look like care delivery businesses with proprietary technology rather than hardware vendors with service add-ons. The next test is whether this model can maintain growth as system sales plateau and whether it can set a new standard for evidence that reshapes coverage criteria across the category.
Jon Napitupulu is Director of Media Relations at The Clinical Trial Vanguard. Jon, a computer data scientist, focuses on the latest clinical trial industry news and trends.
