Full Transcript: Axogen Q1 2026 Earnings Call

Axogen (NASDAQ:AXGN) released first-quarter financial results and hosted an earnings call on Tuesday. Read the complete transcript below. Benzinga APIs provide real-time access to earnings call transcripts and financial data. Visit https://www.benzinga.com/apis/ to learn more. The full earnings call is available at https://event.choruscall.com/mediaframe/webcast.html?webcastid=GnrOj3AT Summary AxoGen Inc reported first quarter 2026 revenue of $61.5 million, a 26.6% increase compared to the same period in 2025, with strong growth across all target markets. The company is making progress on its six strategic priorities, including revenue growth, market development, commercial expansion, and research and development, with a focus on making peripheral nerve repair a standard of care. AxoGen Inc raised its full-year 2026 guidance, expecting at least 20% revenue growth, a gross margin of 74-76%, and to be free cash flow positive, driven by strong commercial execution and market development initiatives. Full Transcript OPERATOR Good morning everyone. Joining me on today's call is Michael Dale, Axogen's President and Chief Executive Officer. Lindsey Hartley, Chief Financial Officer Michael will discuss first quarter 2026 financial results and corporate highlights. Lindsey will then provide details on financial performance and overall outlook for the year. This will be followed by a question and answer session. Today's call and presentation is being broadcast live via webcast which is available on the Investors section of Axogen's website. Following the end of the live call, a replay will be available on the Investors section of the company's website@www.axogeninc.com. before we begin, I would like to remind you that during this conference call management will be making forward looking statements. Forward looking statements include statements regarding financial guidance and outlook, clinical development and regulatory efforts, commercial growth initiatives, reimbursement and market access efforts, training and education initiatives, research and development activities, and overall business strategy and performance. These forward looking statements are subject to risks and uncertainties that could cause actual results to differ materially, including without limitation the risks and uncertainties reflected in the Company's filings with the securities and Exchange Commission, including the most recent annual report on Form 10K, subsequent quarterly reports on Form 10Q and other filings made with the securities and Exchange Commission. Forward looking statements speak only as of the date they are made and the Company undertakes no obligation to update any forward looking statements except as required by law. In addition, for a reconciliation of non GAAP measures, please refer to today's press release presentation with highlights from today's call and the corporate presentation on the Investors section of the Company's website. Now I will turn the call over to Michael. Michael, please go ahead. Michael Dale (President and Chief Executive Officer) Thank you operator and welcome to everyone joining us this morning. What I would like to do today is walk through our first quarter 2026 performance through the lens of the six priority areas of our strategic plan, sharing with you how we executed against each one of those during the quarter. I will then turn the call over to Lindsey to review the financials after which we will open the call for your questions to begin, we are delighted with our first quarter revenue performance and the progress we're making across each of AxoGen Inc's strategic plan priorities. As noted in our earnings release, we delivered strong growth across all of our target markets, reinforcing the relevance of our market development strategies and the strength of our commercial execution. We believe we are well positioned to achieve our financial guidance and continue advancing our strategic priority objectives for 2026. Key first quarter results that underpin our confidence in the remainder of 2026 include revenue of $61.5 million representing over 26% growth year over year, double digit growth across each of our three target markets, continued progress, expanding commercial insurance coverage and payment for advance and the on schedule expansion of our commercial organization combined with our well capitalized balance sheet. These achievements reinforce our confidence in our plans to make restoration of peripheral nerve function and expected standard of care. So let's review in order the progress during the quarter for each of our six strategic priorities. Starting with our first priority revenue growth and financial operating leverage, we delivered a strong start to 2026. First quarter revenue was $61.5 million representing 26.6% growth versus the first quarter of 2025. Growth was broad based with all three target markets contributing to our year over year performance. Adjusted EBITDA was $5.7 million for the quarter and we ended the period with $103.6 million in cash, cash equivalents, restricted cash and investments. Performance was driven by strong demand for events and continued adoption of our broader product algorithm across all three target markets. Salesforce productivity was ahead of plan and our active surgeon count increased meaningfully during the quarter, an indicator we monitor closely because it reflects broader adoption of nerve care within an institution. We are also beginning to see the benefit of the salesforce additions we made in 2025 as those representatives progress through their ramp and approach full productivity within our target market development model. Overall, these results reflect execution across our full commercial system, talent activation, surgeon education, rep productivity coverage expansion and patient awareness and working together in alignment with our strategic plan. Moving on to our second priority, market development across extremities, oral maxill, facial and head, neck and breasts extremities delivered strong double digit year over year growth in the first quarter reflecting continued adoption of the AxoGen nerve repair algorithm across both traumatic and chronic peripheral nerve injury presentations. Momentum in our OMF and head and neck market continued in Q1, delivering strong double digit year over year growth. Increased investments in professional education and a stronger focus and presence in head and neck help drive surgeon activation and algorithm adoption in these procedures. Breast was our fastest growing market in the first quarter delivering strong double digit year over year growth. We are seeing momentum in recent adoption overall and implant based reconstruction volumes. Specifically. We also believe we are beginning to see the productivity contribution of the sales representatives we added to the breast organization the summer of 2025 as those reps ramp and become more productive in their accounts. Before I move on, I want to take a moment to revisit how we think about the size and nature of each of these markets because it is directly relevant to understanding what we are doing and what we believe is possible. When we introduced our Total addressable market framework at the March 2025 Analyst Day, we were deliberate in how we estimated our market opportunities. Our TAM estimates are based on procedure volumes captured from cms, QDMD clinical literature, and the ASPS data. For each segment, we apply a discounting algorithm to remove procedures where an AxoGen product would not realistically be indicated. We then apply expected algorithm usage based on historical utilization data and apply a procedure ASP. The resulting TAMs we believe, are genuinely addressable in extremities I.e. $2.9 billion, including traumatic and chronic nerve injuries segmented by gap length across sensory, mixed motor and protection applications. In breast the TAM is segmented by autologous and implant based reconstruction and represents approximately one third of the more than 150,000 reconstruction procedures performed annually in the United States. In OMF and head and neck, the TAM includes nerve reconstruction and protection across mandible reconstructions, iatrogenic injuries, neck dissections, peritidectomies, thyroidectomies. Roughly 90% of targeted OMF head and neck procedures occur in approximately 900 accounts in the United States, most of which already overlap with our high potential account universe. And in prostate, TAM includes approximately 110,000 annual robotic assisted radical prostatectomy cases with a well defined, well documented clinical problem. While we believe the patient numbers reflected in our TAM represent genuinely addressable treatment opportunities, it's important to be clear that these are markets still in development. We are building them in real time, and our strategic plan reflects the work required to establish standards of care and in doing so, to develop these markets. As we said about a year ago, the question for action is not whether the problems are large and whether our products work, it's what business models are required to connect patients with providers. Each market has a different patient journey, variants in microsurgical knowledge and training, different referral dynamics, and a different reimbursement environment in extremities. While we've made strong progress developing the market and advancing our standard of care objectives, we remain significantly underpenetrated relative to the size of the opportunity. There's still meaningful work to do to ensure nerve care is reflected in care guidelines across the full range of treatment presentations. In breast Most women are not aware that numbness and loss of sensation can be a consequence of a mastectomy. Even when patients understand this risk, they're often unaware our procedure is an option until after numbness has already occurred in OMF and head and neck. We're still below 1% penetrated with an account universe that our current sales organization already covers. In prostate, we continue to refine the clinical technique. This work has been underway throughout 2025 and we believe we are making good progress across all of these markets. The work is about creating the conditions under which peripheral nerve repair becomes an expected standard of care. While there is still significant work ahead, this development Runway is a key reason we believe Atxigen has the opportunity to deliver double digit growth for many years as the potential to restore health and improve quality of life is enormous. With regards to our third priority, commercial expansion, we ended the first quarter with a total commercial organization of 146 sales representatives across all markets reflecting continued discipline expansion in line with our full year plan. Salesforce productivity was ahead of plan in both our breast and non breast organizations in the first quarter, which is an encouraging early data point as 2025 hires continue to ramp. Representatives hired in 2025 are progressing toward independence and breakeven within our six to nine month target window and we expect them to be increasingly accretive through the remainder of the year. Now, just to give you some context for why this matters in terms of our historical trajectory, Accident has not expanded its sales organization for more than three years prior to us beginning this process, so we're just now beginning to see contributions of this build and we believe it will be a meaningful driver of our growth going forward. The fourth priority is commercial excellence, specific to our emphasis on high potential counts, productivity and education. High potential accounts continue to be a primary engine of our revenue growth representing 60% total revenue. For the first quarter, growth from high potential accounts represented 48% total revenue growth in the quarter below our full year target of 60%. This difference reflects strong performance in breast accounts which are not always designated as high potential accounts. We view this as a mixed dynamic rather than a structural concern and it simply reflects that we are seeing high growth all accounts and market segments. Our active surgeon count in high potential accounts increased by more than 70 in the quarter reflecting continued progress in our efforts to make nerve care awareness and skills part of more surgeons repertoires and their practices. In the first quarter we conducted four professional education programs, two in breast, one in extremities and one in OMF and Head&AG. Consistent with our market development plans, we remain on track toward our full year targets of 10 extremities programs training 200 surgeons, six oral, maxillofacial and head and neck programs training 100 surgeons and five breast programs training 75 surgeon pairs as I have often mentioned, education is truly one of Axogen's core competencies. I have been consistently impressed by what Axogen has built and the trust it has earned within the clinical community. As a reminder, we support the training of the majority of hand Fellows in the United States in nerve care and are increasing our investments in Fellows training in our other markets as this is key to establishing nerve care as part of their clinical practice in the future. We are regularly sought out to lead and support these educational programs. As awareness of nerve care continues to build and with more than 70% of the clinical literature on the subject published we just the last five years, we expect demand for education and for training associated with our algorithm to continue to grow. Our fifth priority relates to our standard care objectives specific to evidence coverage and the FDA Biologic License approval or lavance. We continue to make progress Expanding Commercial coverage Since receiving biologics license approval for advance in December 2025, we have been actively reengaging payers where prior objections to coverage and payments were centered on the perception that advance was experimental. I'll share two recent updates. First, CIGNA in mid April, CIGNA extended explicit broad coverage to advance nerve graft for peripheral nerve repair in extremities and post mastectomy breast reconstruction for its approximately 16 million members. Cigna's breast related coverage criteria states advanced nerve graft is considered medically necessary when used in association with mastectomy or breast reconstruction procedures when nerves cannot be preserved. We believe this medical policy update means surgeons and patients will no longer face denials for extremity breast and head and neck no math procedures. Second, lvantse, also known as anthem. In early April, LVANCE removed ANTS from its experimental investigational list, which is an important first step. However, LVADs also implemented utilization management criteria limiting advanced usage to 5 to 25 millimeter nerve gaps, consistent with what we studied in the Recon Pivotal trial. It is common for medical policy teams to initially adopt the inclusion and exclusion criteria from the Pivotal trial for a newly approved drug or biologic and we believe that is what drove alivance's decision. As we have said before, EVANCE is unique. While the BLA approval makes advance feel new to payers, product has 17 years of clinical experience in well over 100 peer reviewed publications. Our Health, Economics and Universal team is currently partnered with more than 15 surgeons to educate Elevantex and resolve this gap link criterion collaboratively. As we communicated at year end, Advanced biologic products will begin entering commercial channels in second quarter 2026 from a customer and physician standpoint, this transition will be largely invisible. Surgeons order advance for its clinical profile, not its regulatory designation, and the product going into their hands performs the same function. There is no inventory obsolescence risk and we have managed the logistics carefully to support a smooth transition. The primary effect of the biologic launch on our financials will be at the gross margin line where we have guided to a 74 to 76% full year range that anticipates the incremental product cost that comes with manufacturing under a biologic quality system. On the clinical study front, we have programs in active development in breast and in mixed and motor nerve indications with initiations expected this year. We will provide more detail on individual programs in the second half of the year. Consistent with our prior guidance in prostate we remain focused on gathering clinical signals from the procedures completed at our 10 clinical sites in 2025 before making any decisions about commercial or clinical study expansion. That data is expected to mature in the second half of the year and we will update investors accordingly when we have something meaningful to share. Finally, our sixth priority which is about innovation, research and development. Therapeutic Reconstruction As a reminder, our R and D work has three primary focus areas. First, making nerve coapitation faster, easier and more consistent. Second, advancing solutions for non transected and chronic nerve injuries through better protection and third, developing therapeutic reconstruction technologies to improve the fundamental biology of nerve regeneration. These are not abstract objectives, they are line of sight improvements to advance into our broader algorithm that we believe will further extend our clinical and competitive position. In closing, first quarter of 2026 was a strong start reflecting disciplined execution of our strategic plan and total commitment to our business purpose of restoring health and improving quality of life by making restoration of peripheral nerve function an expected standard of care like Waddy Piper standards about the Little Engine that could we think we can fulfill our mission purpose and look forward to reporting continued progress across the priorities outlined in our strategic plan. We are raising our full year guidance accordingly. I will now turn the call over to Lindsey to review the quarter's financials and our updated outlook for 2026. Lindsey Hartley (Chief Financial Officer) Thanks Mike. I'm pleased to report our first quarter 2026 financial results. For the first quarter we reported revenue of 61.5 million reflecting growth of 26.6% compared to the first quarter of 2025. Revenue growth continues to be fueled by strong demand for AxoGen and adoption of our product algorithm across target market with unit volume serving as the primary driver. Our gross profit for the quarter came in at 46.2 million this represents a gross margin of 75.2%. Gross margin in the first quarter reflects our pre biologic launch cost structure as AxoGend biologic product has not yet entered commercial channels. Beginning in the second quarter as biologic AxoGen enters the channel we we expect to see incremental product cost pressure. Our full year gross margin guidance of 74% to 76% accounts for this transition and we continue to target improvement in 2027 as we implement continuous improvement programs and benefit from increasing economies of scale. Operating expenses increased to 49 million in the quarter, up from 36.6 million in the first quarter of 2025 and increased 4.5% as a percentage of revenue. The increase as a percentage of revenue was driven primarily by an increase of compensation costs, including stock based compensation expense tied to certain PSUs anticipated to achieve above target on revenue growth. Components, sales and marketing expenses as a percentage of Total revenue increased 3.3 percentage points to 46.6% in the first quarter compared to 43.3% in the first quarter of 2025. This increase reflects investments in our commercial strategy to support our market development initiatives and long term growth plan. Research and development expenses increased 23.4% to 7.5 million in the first quarter compared to 6.1 million in the first quarter of 2025 and as a percentage of total revenue decreased slightly to 12.2% from 12.5%. Our continued investment in research and development, essential to our mission of making peripheral nerve repair a standard of care through the development of clinical evidence and innovation. General and Administrative expenses increased 36.1% to 12.9 million in the first quarter compared to 9.5 million in the first quarter of 2025 and as a percentage of total revenue increased 1.5 to 21% from 19.5%. Net loss for the first quarter was 19.6 million or $0.38 per share, compared to net loss of 3.8 million or $0.08 per share in the first quarter of 2025. Included in net income is one time loss of 16 which was incurred upon the extinguishment of our debt facility in January. Adjusted net income was 4.1 million or $0.07 per share for the first quarter compared to an adjusted net loss of 900,000 or $0.02 per share for the first quarter of 2025. Adjusted EBITDA for the first quarter was 5.7 million compared to an adjusted EBITDA of 2.9 million in the same period last year and as a percentage of revenue increased 3.4 percentage points to 9.3% from 5.9% demonstrating our ability to improve our financial performance. Adjusted net income and adjusted EBITDA are calculated as net income or EBITDA adjusted for stock based compensation and the loss on the extinguishment of the debt. As of March 31, 2026, cash equivalents restricted cash and investments totaled 103.6 million. As expected, we experienced higher cash burn in the first quarter consistent with prior year seasonal patterns and we remain on track to to be free cash flow positive for the full year. As a reminder, in January we completed an upsized public offering raising 1:33.3 million in net proceeds and used 69.7 million to fully retire our term loan. We continue to operate with a clean capital structure and no debt obligations. Based on our first quarter performance and visibility into the remainder of the year, we are raising our full year 2026 financial guidance. We now expect full year 2026 revenue growth of at least 20% or total revenue of at least 270 million. Full year 2026 gross margin is expected to remain in the range of 74% to 76% and we continue to expect to be free cash flow positive for the full year 2026. This guidance reflects continued confidence in commercial execution across all three core markets and the ongoing sales force productivity improvement. It does not assume material benefit from payer coverage decisions beyond what is already known. With that, we will now open the line for questions. Operator OPERATOR thank you. We will now be conducting a question and answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate that your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. We ask that analysts limit themselves to one question and a follow up so that others have the opportunity to do so as well. One moment please. While we poll for questions, our first question comes from Michael Sarcone with Jefferies. Please proceed with your question. Michael Sarcone (Equity Analyst at Jefferies) Good morning and thanks for taking the questions. So just two for me on guidance to start. You know, really nice quarter with the 27% growth and you're expecting at least 20% for the full year, which implies a decel as we make our way through the year. Just wanted to kind of hear you elaborate on what's driving that, the moving pieces there and how much of the guide continues to reflect prudence. Michael Dale (President and Chief Executive Officer) Thanks, Mike. So, to your question as we look at the comparables on a going forward basis, there's a sequential increases that we're going to be comparing against. And this is a commercial execution story, as we've advised continuously. And so our guide in part reflects that reality. So still very, very confident about the future, very confident about the guidance we just raised, but mindful of the fact that each quarter is a productivity growth expectation that we need to continue to execute against. Michael Sarcone (Equity Analyst at Jefferies) Got it. Thanks, Mike. And then just a follow up there, you know, I believe Lindsey mentioned, you know, the guide is about continued execution here. And I think she also finished with, on the reimbursement coverage side, you know, nothing beyond what we already know. I know the prior guide didn't have any, you know, of the potential coverage wins baked in. We've seen Anthem and Cigna, you know, we may see an Aetna update soon, I guess. Can you talk about if there's anything in the guide related to progress there even, even modestly? And then, you know, the follow up to that is, you know, how do you view timelines for seeing more of a contribution from some of the recent commercial coverage wins? Michael Dale (President and Chief Executive Officer) Thank you. Sure, Mike. We're digesting realities of that, of that impact in real time. As we often mentioned, these are not events, when you join achievement, that immediately translate into activities. These need to be socialized within the relative providers across the country. They then need to negotiate their individual contracts as part of that. So we know it's all going to be a net positive in a significant way, but it is not an event that happens immediately. And so I think really, as the next quarter rolls out, start to get some insights into that and speak more to it. But again, it's just not an instantaneous benefit. Great. Michael Sarcone (Equity Analyst at Jefferies) Thanks a lot, Mike. Sure thing, Mike. OPERATOR Our next question comes from Larry Beagleson with Wells Fargo. Please proceed with your question. Larry Beagleson (Equity Analyst at Wells Fargo) Good morning. Thanks for taking the question and congrats on a really nice quarter here, Mike. You know, the growth obviously accelerated here in Q1. Maybe a little bit more color on what drove the acceleration here. And with the new, you know, 20% plus, you know, guidance here, how are you thinking about the LRP of 15 to 20%? Michael Dale (President and Chief Executive Officer) Sure. With regards to first quarter, really what we're seeing is cumulative effects of all the things we've been discussing now for quite some time. The ramp of the physical footprint, those individuals coming into play, the continuing benefits of the market development activities in terms of positioning awareness. Each part of the business is getting just a little bit better each quarter. And so it's no one single thing, no one single part of the business that's the most comforting thing to the team is that we're not dependent upon any one part of the business. They're all doing well. And it just reflects the fact that these are real needs from a health standpoint grossly under treated and we're making little progress each quarter towards that. So that's really what's driving the growth. There's really no magic to it. It's all of the things underlined in our strategic plan descriptions. And so we're benefiting from that. In terms of the lrp, we have not made any adjustments to a long range plan. We still think that 15, 20% stands. As this year plays out and as we start to digest more about payment and coverage progress, that may change. But for now we have not adjusted. Larry Beagleson (Equity Analyst at Wells Fargo) That's helpful. Mike, for my follow up on prostate, what are the early signals you're seeing from 100 patient cohort ahead of the second half readout? And can you put a finer point please on the timing of the readout? Thank you. Michael Dale (President and Chief Executive Officer) In terms of the timing of the readout, in terms of substance to where we could really begin to make judgments, that's still on schedule as previously described, which is the end really getting into third quarter and the reason why we'll have a, we'll have a body of patients that we can draw conclusions from as that happens at present, what we have in terms of feedback is best described as anecdotal individual experiences. And those are all positive. But I need to emphasize those are anecdotes, not data body of significance that you can truly base decisions upon. Larry Beagleson (Equity Analyst at Wells Fargo) All right, thanks for taking the question. Michael Dale (President and Chief Executive Officer) Sure thing. OPERATOR Our next question comes from Mike Kratke with Lee Rink Partners. Please proceed with your question. Mike Kratke Hi everyone, thanks for taking our questions and congrats on the really nice quarter and recent progress. Maybe just to follow up on Pros 8 quickly. So in terms of the specific updates or that clinical activity signal that you're looking for, what are going to be the specific metrics that you're focused on that will influence your commercial outlook there? Sure. Michael Dale (President and Chief Executive Officer) Jens, why don't you address that question? Jens Yeah, I mean we're looking at basically we're following these patients very closely or the sites that we're working with are following patients very close to individual, looking for clinical signs for potency, incontinence. And the other objective with working with the clinical sites was to see how incorporating nerve grafting into robotic procedures influenced the workflow and what we've Seen is it's very easy for these highly trained surgeons to incorporate advance into robotic procedures. So that's another key that we've gotten so far. So overall very positive. But as Mike said, we'll report further on kind of the clinical science in the second half of the year. Understood. Appreciate the color there. And maybe just as a follow up, it looks like in the latest corporate deck you mentioned that 14% of commercial lives remain uncovered. So, you know, curious not to get ahead of any updates, but if you do see an update from Aetna, how close to full coverage could that get you and how widespread is the coverage within those different plans today? Michael Dale (President and Chief Executive Officer) Rick, why don't you take that question? Rick Yeah, happy to do it. Good question. It would put US in the mid-90s extended coverage and there are a couple regional payers out there that we certainly communicated with in our target markets. We feel really good about that. The term we like to use instead of saying full coverage is near universal. But I wake up every day feeling pretty good. If we have Aetna making a coverage decision and then timing on that because you guys are probably curious, you know, we expect something by the end of June, but that's based on historical updates. So trust that I wake up every day and refresh that webpage and try to see what the news is. Mike Kratke Thanks very much. Appreciate the caller. Rick Thanks Mike. OPERATOR Our next question comes from Jason Bedford with Raymond James. Please proceed with your question. Jason Bedford (Equity Analyst at Raymond James) Hi, good morning and congrats on the progress here. I guess just are you selling BLA product today and if not, when will it be launched? And then just as my follow on, I'll ask it up front, is there a different launch strategy specifically around price area of focus? Any detail there would be great. Michael Dale (President and Chief Executive Officer) We are now selling BLA produced product. There is no change in the pricing structure and in terms of general positioning, effectively no change beyond the presentation to customers that the product is now the first biologically approved therapeutic solution for providing physical scaffolds for treating nerve discontinuity. So we remind people of the criteria that was required of that process and oftentimes thank particularly the existing customers for their support and confidence in the product over the years. So but effectively it business as usual for the surgeon doing that kind of work. Jason Bedford (Equity Analyst at Raymond James) Thank you. OPERATOR Our next question comes from Kaitlyn Roberts with Canaccor Genuity. Please proceed with your question. Kaitlyn Roberts (Equity Analyst at Canaccord Genuity) Hi, thanks. Congrats on GreatCorps and thanks so much for taking the questions. You know, just to ask again on the biologic product transition, does that change really the method or the Regulatory procedures by which a new hospital or the VAF committees within the new hospital would approve of Vance or did that really occur with the BLA approval? Michael Dale (President and Chief Executive Officer) There's no change whatsoever in the activities that you asked about. The transition is effectively invisible to the customer. Kaitlyn Roberts (Equity Analyst at Canaccord Genuity) Got it. Understood. And then just thinking about, you know, the commercial coverage currently, how many, if any of you know, the current payers have any restrictions on the length and the type of nerve based on, you know, the recon study or you know, what was approved under the BOA and then conditionally approved under the boa. Michael Dale (President and Chief Executive Officer) Rick, why don't you go ahead and address Caitlin's question. Rick Yeah. Hey Caitlin, good question. So elevance first is good news, right? Elevance removed us from the investigational experimental list. We were surprised that they chose the recon gap length and put that criteria on there. We've actually already engaged them and have consistent communication. We feel it's inappropriate for a few reasons. First is to pre authorize on gap length to is just surgically inappropriate because you don't know the gap length until you get into the operating room. So we educated them on that. And if you go read the medical policy update, there are three key omissions. One of them is there's no mention of the bla. The second is there's no mention of the biggest systematic review and meta analysis on nerve repair which shows that advance is as effective as autograft in long gaps. And the third is they don't mention either of the specialty society position statements that were issued last year. So we've submitted this to them. We expect there will be an update sometime, hopefully by the end of this year or early next year to correct this. But we think it's just an honest error on their part. But they've been collaborative and we look forward to addressing it here in the near future. Kaitlyn Roberts (Equity Analyst at Canaccord Genuity) Great, thank you so much. Michael Dale (President and Chief Executive Officer) Thanks, Caitlin. OPERATOR Our next question comes from Anthony Petrone with Mizuhu Group. Please proceed with your question. Michael Dale (President and Chief Executive Officer) And congrats on the quarter here. Strong execution. Maybe to go back to breast resensation. Mike, you mentioned five programs. You have 75 surgeons in there and each of these end markets are a little bit different. So maybe when you have a program that's ongoing, you're training surgeons. What has been the average conversion rate to an active implanter and how does that stack up to breast? Is it similar in extremities to breast or is the conversion curve look a little bit different? And I'll have one follow up Anthony Petrone (Equity Analyst at Mizuhu Group) with regards to breast and I'M generalizing here, but the historical conversion rate has been above 75%. Michael Dale (President and Chief Executive Officer) That cell phone maybe and that is that across all end markets or that that's breast specifically. Anthony Petrone (Equity Analyst at Mizuhu Group) It's breast specifically. Michael Dale (President and Chief Executive Officer) Okay. And then maybe just to recap, when we think about, you know, pushing into these new markets breast and prostate, just a recap of the amount of graft per case. You know, what does it look like in breast and potentially prostate if we get there relative to core extremities? Thanks, Jens, why don't you address that? Yeah. So in a breast reconstruction procedures we typically see bilateral reconstructions, which means two grafts per procedure. In prostate it depends whether or not it's a unilateral nerve sparing or bi bilateral or sorry or a non nerve sparing procedure. So it could be one graft if it's just one or two grafts if it's both sides that meets the prostate that needs reconstruction. So it depends on the mix. Thank you. Frank Tikinen (Equity Analyst at Lake Street Capital Markets) Our next question comes from Frank Tikinen with Lake Street Capital Markets. Please proceed with your question. Michael Dale (President and Chief Executive Officer) Great. Thank you for taking the questions. Congrats on the quarter. I was hoping to start on sales reps. Mike, I think I heard you call out 146 reps reps. Could you parse out between the different units that you have in the past between extremities and breast? And then as a second part to that, I think you previously guided for 130 extremities and 30 breast reps by year end. With some of the positive developments and momentum so far in 2026, could you see yourself potentially hiring ahead of that plan? Frank Tikinen (Equity Analyst at Lake Street Capital Markets) The answer to the last question is yes. We're always looking at that. The key element is making sure we maintain quality control and logistically so, yes, constantly monitoring that. The primary expectation is to stay on schedule at a minimum. In terms of the breakouts, we have 26 reps now in place and we have three regional sales directors. And then extremities we have 120 reps in place and 15 regional sales directors. And in OMF head and neck we have four field based market managers who support that effort. And in prostate we have three clinical development managers and one director who manages the program. Lindsey Hartley (Chief Financial Officer) Great, that's helpful. And then just as a follow up on some of the gross margin commentary, any other details you can provide on cadencing of margins? Should we expect that Q2 impact given it's the first quarter of BLA product to be more pronounced or will it actually be less pronounced as it is? Transitioning and then through the back of the year you could see it either go up or down. Any color on that would be helpful. Michael Dale (President and Chief Executive Officer) Yes. Hi, Frank, this is Lindsey. For this quarter Q2 that we're in right now, we expect to be at the lower end of that range where we should see the most pressure from transitioning to the bla. And then for each quarter, we should expect to be within that range and here as well. Dave Turkley (Equity Analyst at Citizens) Thanks, Frank. Rick Our next question comes from Dave Turkley with Citizens. Please proceed with your question. Dave Turkley (Equity Analyst at Citizens) Hey, good morning. Congrats. I'd follow up one for Rick. You know, looking at some of the decisions from the insurance companies and noting that, you know, they called out some of the specific indications like breast. Is that common? Do you expect that you might need to go back to some of these payers to get like a broader coverage or was that expected for some of these, you know, insurers to kind of call out specific target areas like that? Michael Dale (President and Chief Executive Officer) Thanks for the question, Dave. Our label on the BLA is quite broad and we expected the coverage criteria that the payer set will continue to be broad and you can see it in the growth in all of our markets. So I don't think we're going to have to go back to, well, too much. But look, we stay pretty well connected with our sales force with surgeons out there. If we hear of denials, we're pretty engaged. And as you can tell, we got pretty consistent communication with medical policy teams out there. So we don't expect any big hiccups. If we run into any hurdles, we'll go collaborate with the payers and try to knock those down in due time. But look, the product's been on the market 17 years. We got well over 100 publications and we have society position statements and BLA approval. So we've got a pretty strong case for coverage and a really good evidence package. OPERATOR Thank you for that. And then maybe Mike just, you know, doesn't seem like you need to do anything but invest kind of in organically here, but 100 million on the balance sheet now, just thoughts on the world you're operating in. Are there M and A activity or opportunities specifically in nerve repair that you're looking at? Sure. Kayte With regards to the cash, as we've mentioned in the past, we have significant infrastructure development underway from a capital allocation standpoint in terms of systems. So we'll continue to deploy cash for those purposes. And then if we opportunistically see assets that would further burnish our business purpose, we'll absolutely Pay attention to deploying cash for that purpose. But there's kind of day to day hygiene you might say as an expectation from our viewpoint. Thank you. Thanks Dave. Michael Dale (President and Chief Executive Officer) Our next question comes from each and one with HC Wainwright. Please proceed with your question. Jens Hi, good morning. This is Kayte on for yi. Kayte I was hoping we could get a little bit more color on maybe percentages or how the breakdown is working out in your percentages of growth. So like new surgeons versus existing account expansion. I know you said you were getting more people on board at existing facilities, but are you getting more locations and are you seeing more new indications versus those core trauma? Just trying to get a feel for if growth is becoming is kind of concentrated or if it's getting more diversified Michael Dale (President and Chief Executive Officer) as you go along. OPERATOR Well, I'll ask Jens to weigh in on this as well. But this is a general statement. So the key driver in terms of overall growth is numbers of surgeons and the relative productivity of individual surgeon practitioners. So both are key elements. The third in that line would be adding the number of accounts primarily driven by oral, maxillofacial and breast. The number of accounts on the extremities would be is also growing, but only incrementally as compared to the others. So that from a source standpoint that's the hierarchy in terms of contribution. Dell Yeah, I think Mikey said it well. I think the key takeaway is that based growth we're seeing surgeon activation across all of our markets and the same for new. So it's really broad based. We continue to have a strong focus in our high potential accounts. Saw strong growth here as well this quarter but it really is broad based growth across all of our markets. A Thank you guys so much. ladies and gentlemen. That concludes our question and answer session. I'll turn the floor back over to Mr. Dell for any final comments. E Thank you, operator. On behalf of the action team, I want to thank everyone for their time and interest in our work to fulfill the promise and potential for all stakeholders of our business purpose, which is to restore health, improve quality of life by making restoration of peripheral nerve function expected standard of care. B We look forward to updating you on E our continued progress on our earnings call next quarter. Thank you very much. A Thank you. That does conclude today's teleconference and webcast. You may disconnect your line at this time and have a wonderful day. We thank you for your participation today. Disclaimer: This transcript is provided for informational purposes only. While we strive for accuracy, there may be errors or omissions in this automated transcription. For official company statements and financial information, please refer to the company's SEC filings and official press releases. Corporate participants' and analysts' statements reflect their views as of the date of this call and are subject to change without notice.