iRhythm Technologies (NASDAQ:IRTC) reported fourth-quarter and full-year 2025 results that management described as a “breakout year,” highlighting strong volume-driven growth, margin expansion, and the company’s first quarter of positive net income. Executives also laid out expectations for 2026 and addressed investor questions on Medicare-related documentation scrutiny, international expansion, and the company’s next-generation mobile cardiac telemetry (MCT) product timeline.
Q4 and full-year results: strong growth and profitability milestones
Chief Financial Officer Dan Wilson said fourth-quarter 2025 revenue was $208.9 million, up 27.1% year over year, while full-year 2025 revenue reached $747.1 million, up 26.2% versus 2024. Management attributed performance primarily to sustained volume demand across channels, with some favorable pricing dynamics in the quarter and year.
On profitability, gross margin in the fourth quarter was 70.9% (up 90 basis points year over year), while full-year gross margin was 70.6% (up 170 basis points). Wilson said the improvement reflected operational efficiencies in manufacturing, automation, and workflow optimization, along with scale benefits, partially offset by product mix.
Operating expenses in the fourth quarter rose to $145.8 million from $119.2 million a year earlier; full-year operating expenses totaled $584.7 million, up 11.8%. Despite higher spending, management emphasized operating leverage, with revenue growing faster than expenses.
The company posted net income of $5.6 million, or $0.17 per diluted share, in Q4—its first positive quarterly net income. For the full year, iRhythm recorded a net loss of $44.6 million, or ($1.39) per diluted share.
Adjusted EBITDA in Q4 was $34.3 million, representing a 16.4% margin and a 470-basis-point improvement year over year. Full-year adjusted EBITDA was $68.9 million, or 9.2% of revenue, which Wilson said was an improvement of more than 1,000 basis points compared with 2024 (and more than 500 basis points when normalizing for IP R&D expenses).
iRhythm generated $14.5 million in free cash flow in Q4 and $34.5 million for the year, ending 2025 with $583.8 million in cash, cash equivalents, and marketable securities. Wilson called 2025 the company’s first year of positive adjusted EBITDA and free cash flow.
Market positioning: primary care growth, EHR integration, and AI pilots
President and CEO Quentin Blackford said growth remained volume-driven across cardiology, primary care, innovative channels, and international markets, with Q4 marking the company’s fifth consecutive quarter above 20% revenue growth. Blackford said iRhythm maintains nearly 72% share in long-term continuous monitoring, a segment he described as growing in the “high teens,” and cited more than 135 scientific publications.
Blackford emphasized a shift “upstream” in detection, noting that more than one-third of iRhythm’s volume originated in primary care settings in 2025. The company said it serves approximately 40,000 primary care physicians and positioned its approach as complementary to cardiology, enabling cardiologists to focus on higher acuity patients while primary care becomes an earlier detection point.
Management also highlighted its EHR strategy. Blackford said more than half of iRhythm’s volume flows through EHR-integrated accounts, and 75 of the top 100 customers are fully integrated. In the Q&A, Wilson added that Epic remains a “terrific partner,” clarifying that the 75 figure refers to all integrated systems across EHR platforms, not only Epic. He said iRhythm had a record number of Epic integrations in Q4 and was on pace for another record in Q1, and added that iRhythm’s data shows roughly a 25% increase in prescribing volume about six months after integration—though he said that uplift was not built into 2026 guidance.
On AI and predictive programs, Blackford said iRhythm has nearly 3 billion hours of curated ECG data and is combining internal and external data sets, including claims and EHR information, to identify patients at risk before diagnosis. He pointed to early pilots through a partnership with Lucem Health showing more than 85% accuracy in pre-identifying patients with clinically relevant arrhythmias, and later said accuracy rates have been “as high as 90%” in early trials discussed with innovative partners. Blackford argued iRhythm’s differentiation is not just software, but also purpose-built hardware for clean ECG signal capture, FDA-cleared algorithms requiring years of validation, established reimbursement and workflow integration, and scale of patient data (including 13 million patients referenced in the Q&A).
MCT business: Zio AT momentum and next-generation device timeline
Blackford said the company’s current MCT offering, Zio AT, continues to perform “exceptionally well,” with unit growth running more than twice the company average. In the Q&A, he said Zio AT grew north of 50% for the year, and noted sequential growth in Q4. Management said iRhythm has roughly 15% market share in the MCT market, compared with 72% in long-term cardiac monitoring, and stated that every 10 points of MCT market share gains represents about $80 million to $100 million of incremental annual revenue.
Blackford said iRhythm’s next-generation MCT device is under FDA review and is expected to launch in the first half of 2027. He described planned features including 21-day wear time, an improved form factor aligned with the Zio monitor, and enhanced algorithms.
A key update involved the product’s gateway. Blackford said iRhythm is moving to a mobile gateway and away from its older gateway, citing FDA expectations and cybersecurity-related questions. He explained that the initial mobile gateway will be a locked “smart device” provided with each shipment and used only to communicate with the MCT product, not an app on a patient’s own smartphone. A future iteration could potentially move to the patient’s phone, he said, but that would not be the first release.
International and adjacent opportunities
Blackford said iRhythm is commercial in the U.K., select E.U. markets, and Japan—markets that collectively conduct over 3 million ambulatory cardiac monitoring tests annually—while iRhythm holds less than 1% share. He said the U.K. delivered its largest quarter of volume ever and that iRhythm will participate in pilots under the NHS Supply Chain’s value-based procurement program. In Japan, he said the company is generating in-country evidence to support future reimbursement reconsideration applications to the MHLW.
Wilson said international growth is expected to run slightly ahead of overall company growth in 2026, with more meaningful contribution expected in 2027 and beyond given that five of the six markets were opened in roughly the last 18 months.
Blackford also referenced “encouraging progress” in sleep pilots, citing an estimated nearly 40 million sleep apnea patients in the U.S. and overlap with arrhythmia populations, though he did not provide financial impact metrics.
2026 outlook and Medicare documentation questions
For 2026, Wilson guided to full-year revenue of $870 million to $880 million, representing 16% to 18% growth. First-quarter 2026 revenue is expected to be $193 million to $195 million, reflecting typical seasonality.
Profitability guidance calls for adjusted EBITDA margin of 11.5% to 12.5% for the full year 2026, with first-quarter adjusted EBITDA margin expected at 3% to 4% due to seasonal expense patterns. On gross margin, Wilson said iRhythm expects incremental improvement in 2026 and later quantified that as approximately 80 to 100 basis points above 2025 levels.
Wilson said pricing is expected to be approximately flat in 2026 versus 2025. He explained that while Medicare rates for long-term continuous monitoring (Zio monitor) are up in 2026, Medicare is about 25% of the business and MCT category rates for Zio AT are “slightly down” year over year, making overall price flat when considering product and channel mix. He also detailed that pricing in 2025 benefited from improved collections versus estimates, leading to a one-time “true up” of low single-digit millions in Q4, while emphasizing strengthened market access, contracting, and revenue cycle performance.
Management repeatedly addressed questions about heightened scrutiny of “chart-derived diagnosis” and chart-scraping practices. Blackford argued that Zio supports a confirmatory diagnosis that integrates into medical records and could reduce audit exposure. He said he viewed the situation as a potential tailwind but emphasized that iRhythm did not factor any such benefit into forward-looking guidance. In response to follow-up questions, he said he expected any tailwind to be driven more by self-directed changes in provider behavior than by regulatory directive.
On the innovative channel, Wilson said it remains low single digits as a percentage of the overall business, trending upward in 2025. He said guidance assumes an incremental step up from the run rate exiting 2025, with the company taking a “disciplined approach” given lower visibility in newer channels.
About iRhythm Technologies (NASDAQ:IRTC)
iRhythm Technologies, Inc is a medical technology company that develops and commercializes wearable cardiac monitoring devices and associated data analytics services. Founded in 2006 and headquartered in San Francisco, California, the company’s flagship product is the Zio® patch, a discreet, single-use, continuous ECG recorder designed to monitor heart rhythms for up to 14 days. iRhythm’s digital diagnostics platform combines biosensor technology with proprietary algorithms to detect arrhythmias and streamline data interpretation for physicians.
The Zio service is prescribed by cardiologists and other healthcare providers to aid in the diagnosis of atrial fibrillation, bradycardia, tachycardia and other rhythm disorders.
