Lumexa Imaging (NASDAQ:LMRI) reported fourth-quarter and full-year 2025 results that management said exceeded its preliminary earnings announcement, marking the company’s first earnings call as a public company following its IPO. Executives highlighted revenue growth, expanding adjusted EBITDA margins, and progress on technology and expansion initiatives heading into 2026.
Fourth-quarter results and operating metrics
For the fourth quarter of 2025, Lumexa posted consolidated revenue of $267.7 million, up 7.9% year over year. Adjusted EBITDA rose to $63.8 million, an 18.6% increase from the prior-year period, producing an adjusted EBITDA margin of 23.8%.
CFO Tony Martin said quarterly revenue growth was “most heavily driven” by the company’s return in-network with a large payer in New Jersey. He also cited increased procedure volumes in other locations and a continued mix shift toward advanced imaging modalities such as MRI, CT, and PET, which carry higher reimbursement rates. Revenue per unit benefited from what management described as modest increases in contracted rates with payers.
Full-year 2025 performance and balance sheet actions
For full-year 2025, Lumexa reported consolidated revenue of $1.023 billion, up 7.8% from 2024. System-wide revenues increased 8.2%, and adjusted EBITDA rose to $230.2 million, up 14.6% year over year, representing a 22.5% adjusted EBITDA margin.
On a GAAP basis, the company reported a fourth-quarter net loss of $28.7 million, compared with a net loss of $25.1 million in the prior-year quarter. Martin attributed the quarterly GAAP loss to expenses related to debt refinancing and other transaction costs tied to the IPO year.
Management emphasized deleveraging and liquidity improvement in 2025. Lumexa ended the fourth quarter with $58.8 million in cash and cash equivalents, up from $26.1 million at the end of 2024. Martin said the company reduced leverage by more than half a turn through operations during 2025, then reduced leverage by an additional two turns to 3.5x levered EBITDA in December using $406 million of net IPO proceeds to pay down debt.
Martin also said the company received improved credit ratings from S&P and Moody’s to B+ and B2, respectively, and refinanced its term loan at a more favorable interest rate. The combined effect is expected to generate more than $50 million in anticipated annual cash savings.
Regarding joint ventures, Martin said total debt at unconsolidated health system JVs was $69 million at year-end, mainly tied to financing equipment purchases. He noted this amount is not included in Lumexa’s balance sheet or lender leverage calculations; including the company’s pro rata share would increase leverage by about 0.15x, according to management.
Growth strategy: same-center execution, expansion, and service lines
CEO Caitlin Zulla outlined priorities for 2026 centered on same-center growth, geographic expansion, joint ventures, disciplined tuck-in M&A, and strategic service line expansion. Zulla reiterated that procedure volume typically drives about two-thirds of revenue growth, with the remainder coming from rate improvement, including higher-acuity mix.
She pointed to several commercial initiatives, including targeted orthopedic outreach during peak surgical season and efforts to increase mammography compliance by leveraging CRM tools and proactive scheduling. Zulla said roughly 85% of screening mammography volume comes from returning patients.
On expansion, Zulla said the company opened nine new centers in 2025, a record for Lumexa, and described de novo development as foundational. She said a typical de novo center reaches breakeven in about one year, with 2024 and 2025 cohorts tracking in line with expectations. Lumexa plans to open 8–10 de novos annually and has already opened its first 2026 de novo in February, with new-site openings expected to be weighted more toward the second half of the year.
Zulla also highlighted joint ventures as a differentiator. She cited a partnership entered in the back half of 2025 with University of Pittsburgh Medical Center, which expands Lumexa’s footprint into Pennsylvania and brings its reach to 14 states. The company is also evaluating tuck-in acquisitions; Zulla noted one small tuck-in facility acquisition in North Carolina completed at the end of the fourth quarter, described as an extension of the company’s partnership with Atrium Health.
On service lines, management discussed breast arterial calcification (BAC) screenings as a cash add-on assessment for cardiac health at mammography locations in South Jersey, saying acceptance has been strong. Zulla also pointed to PET as a growth contributor in 2025, including amyloid PET exams connected to the company’s Alzheimer’s Center of Excellence. She said full-year PET volumes increased at a mid-teens percentage on both a consolidated and system-wide basis.
Technology and efficiency initiatives
Management discussed several technology initiatives aimed at improving throughput and efficiency. Zulla said AI-enabled faster scanning technology has increased schedule throughput by nearly 40% since introduction while improving image clarity. The rollout was approximately 50% complete across centers by the end of 2025, with an expected increase to about two-thirds adoption by the end of 2026.
On the call, Zulla provided an example of “Fast Scan” reducing a Siemens ankle MRI exam from 22 minutes to 8 minutes. She said the capability can be added either through new equipment or a software bolt-on, which she priced at about $150,000.
The company is also integrating “Virtual Cockpit” for remote MRI scanning, which Zulla said can reduce downtime, provide staffing flexibility, and extend hours. Additionally, Lumexa reached an agreement in the fourth quarter to partner with Ferrum Health, described as an AI convener that provides access to FDA-cleared imaging AI applications through a single integrated pathway.
2026 outlook and first-quarter timing factors
Martin reiterated full-year 2026 guidance, unchanged from a pre-announcement, calling for revenue of $1.045 billion to $1.097 billion and adjusted EBITDA of $234 million to $242 million. The adjusted EBITDA outlook includes approximately $7 million of public company costs not incurred in 2025. The company also introduced adjusted EPS guidance of $0.71 to $0.77.
While the company does not provide quarterly guidance, management said the first quarter is typically the lowest due to seasonality, with the fourth quarter strongest due to patient behavior ahead of deductible resets. For Q1 2026, management cited two unusual dynamics: some pull-forward of January volumes into December, and storms affecting volumes in New Jersey, Texas, and three other southern states. The company said it expects Q1 adjusted EBITDA to be approximately flat compared to Q1 2025 but maintained confidence in full-year guidance, noting efforts to reschedule impacted patients and recover volumes through the year.
About Lumexa Imaging (NASDAQ:LMRI)
We are one of the largest national providers of diagnostic imaging services(1). Our platform is integrated, scalable and has a proven track record of creating value for our stakeholders. As of September 30, 2025, we and our affiliates operated the second largest(1) outpatient imaging center footprint in the United States. It spans 184 centers(2)across 13 states and includes eight joint venture partnerships with health systems. Our centers are in attractive metropolitan statistical areas (“MSAs”).
