MDxHealth SA reported fourth‑quarter 2025 revenue of $30.5 million, up 23% from $24.7 million in Q4 2024, and full‑year 2025 revenue of $109 million, a 21% increase over the $90.0 million of 2024. The growth was driven by a 128% jump in liquid‑based test billings to 27,486 units in Q4 and a 57% rise to 71,920 units for the year, largely fueled by the integration of the Exosome Diagnostics acquisition and the conversion of Select mdx customers to ExoDx. Tissue‑based billings grew 18% to 49,180 units for the year, reflecting steady demand in the core prostate cancer testing market.
MDxHealth’s cash balance at year‑end 2025 was $29.0 million, a figure that sits well below the remaining GPS earnout obligations of $54.5 million ($15 million in 2026, $18 million in 2027, and $21.5 million in 2028). The earnout amendment, signed on January 9, 2026, defers and extends these payments and introduces 3 million warrants exercisable at $5.265 per share, signaling management’s need for liquidity and the potential for future dilution. The cash‑to‑earnout gap has become a focal point for investors, as it raises questions about the company’s ability to meet its obligations without additional financing or a significant improvement in cash flow.
Management projected 2026 revenue of $137–$140 million, a 26–28% increase from 2025, and expressed confidence that the expanded product menu and strong sales channel will sustain growth. CEO Michael K. McGarrity noted that “the strength of our sales channel coupled with our expanded menu offering to our urology customer base will continue to drive sustainable growth.” He also highlighted a target adjusted EBITDA margin run rate of 10% by the end of 2026, underscoring a focus on profitability alongside revenue expansion.
Investor reaction on the announcement day was muted, with market participants focusing on the cash‑to‑earnout mismatch. Analysts and market‑watching platforms cited the company’s low cash reserves relative to its earnout commitments as a key concern, despite the solid revenue growth and guidance. The negative sentiment reflects a broader worry that MDxHealth may need to raise additional capital or issue more shares to service the earnout, potentially diluting existing shareholders.
In summary, MDxHealth delivered a strong Q4 and full‑year 2025 performance, driven by a surge in liquid‑based testing volumes and steady tissue‑based demand. The company’s raised 2026 guidance signals confidence in continued growth, but the cash‑to‑earnout gap and the introduction of warrants highlight financial headwinds that could temper investor enthusiasm. The event underscores the importance of balancing aggressive growth with liquidity management in a high‑growth diagnostics business.
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