Exagen (NASDAQ:XGN) executives said the company closed 2025 with record revenue and testing volume, pointing to progress from operational changes made over the past several years, while acknowledging near-term average selling price (ASP) pressure tied largely to a previously disclosed client billing disruption and the ramp of newly launched biomarkers.
Leadership highlights a multi-year operational reset
President and CEO John Aballi framed Exagen’s strategy around improving diagnostic precision and timeliness in autoimmune disease, contrasting what he described as a typical four-month cancer diagnostic timeline with longer timelines in autoimmune conditions such as lupus and rheumatoid arthritis. Aballi said the company has spent the past few years “rebuilding” its operating foundation, including revenue cycle management, commercial restructuring, and a streamlined R&D portfolio.
2025 results: record revenue, volume inflection, and ASP gains on a trailing basis
Chief Financial Officer Jeff Black reported full-year 2025 revenue of $66.6 million, a record and a near 20% increase over 2024. Management attributed the growth to both higher testing volume and ASP expansion on a trailing 12-month basis.
Aballi said testing volume in 2025 reset from roughly 30,000 tests in the first quarter to 35,000+ in subsequent quarters, adding that the fourth quarter was the highest Q4 testing volume in the company’s history for the second consecutive quarter. He also said the company “bucked typical second half seasonality.”
On full-year volume, Aballi later disclosed 137,000 AVISE CTD tests in 2025. He also said Exagen expanded its sales organization to 45 territories, up from about 40 at the start or middle of 2025, and expects productivity to improve as newer reps ramp.
On pricing, Aballi said trailing 12-month ASP ended the year at approximately $441 versus $411 at the start of 2025, an increase of about 7%. Black noted the company experienced “some ASP headwinds in the second half of the year,” which he expects to be transitory.
Biomarker contributions, payer engagement, and the Northwell headwind
Executives provided additional color on product-related ASP contribution and reimbursement progress. Black said that by year-end the combined T-cell and RA33 ASP contribution was approaching $80 per test, nearing the roughly $90 contribution the company anticipates over time. He added that anti-PAD4 biomarkers introduced late in 2025 are expected to contribute at least $10 to ASP over time.
During the Q&A, management repeatedly addressed the impact from a prior client billing change involving Northwell Health. Aballi said the affected volume was about 2% of overall volume at the time and described the impact as approximately a $25 contributor to ASP. He characterized the event as a “one-time setback,” said the company has seen no further degradation, and said volume growth initiatives have already offset lost volume. Exagen reported 22% volume growth in Q4 2025 compared with Q4 2024, according to Aballi.
Management also discussed market access efforts. Aballi said the company recently met with 12 medical directors across various Blue plans and has additional meetings scheduled early in 2026. He also highlighted what he described as a new development: the American College of Rheumatology (ACR) is now advocating for Exagen with payers, following roughly 2.5 years of relationship-building. Aballi said the company has established a channel for rheumatologists to request ACR advocacy into specific commercial plans, and that ACR has confirmed it is advocating with certain medical directors.
On Medicare coverage, management said a local coverage determination (LCD) process remains in progress through MolDX. Aballi said Exagen’s original submission dates back to summer 2022, that the draft LCD is expected to be broader and relate to testing in rheumatologic conditions, and that the company does not have clarity on timing. He added that Exagen’s Medicare reimbursement through its home MAC has not been disrupted and that pricing would not change as a result of an LCD, describing it instead as a public memorialization of coverage that could help with Medicare Advantage and potentially commercial insurers.
Margins, expenses, and cash
Black reported full-year 2025 gross margin of just over 58%, down from about 60% in 2024, which he attributed to ASP pressure in the second half. In response to an analyst question, Black said the rollout of seven new biomarkers increased cost per test, even as the company’s cost of goods per revised CTD test ran below internal targets. Management reiterated confidence that gross margin can move to the mid-60s over time with ASP expansion, scale, and further cost optimization.
Operating expenses for 2025 were $53 million, up about 13% year over year. Black said the growth rate in OpEx was lower than revenue growth, reflecting early signs of scale. SG&A was $47 million and R&D was just over $6 million, with R&D up 16% to support marker launches and pipeline work. Adjusted EBITDA loss was $9.8 million for 2025, which Black said was a moderate improvement from 2024.
Exagen ended 2025 with just over $32 million in cash, cash equivalents, and restricted cash. Black also said the company reduced operating cash burn before debt service and benefited from $26 million in net proceeds from debt refinancing, a follow-on offering, and ATM utilization. He added that the company expects increased accounts receivable and higher cash use in the first half of 2026 due to holding most claims early in the year, with normalization in the second half. Black said that with more than $43 million in cash and accounts receivable at year-end, the balance sheet provides runway to reach sustainable positive free operating cash flow.
2026 outlook and pipeline: revenue guide and a planned annual product cadence
For 2026, Exagen guided to revenue of $70 million to $73 million, with both volume and ASP contributing. Black said the midpoint assumes high single-digit volume growth and low single-digit ASP growth from the Q4 2025 in-period ASP rate, noting the company exited Q4 with ASP slightly below the trailing 12-month level.
Management discussed longer-term profitability targets as well. Black said Exagen believes it can reach breakeven Adjusted EBITDA and begin generating cash at roughly an $80 million revenue run rate, with variation based on ASP and volume mix. He added that this threshold is higher than prior targets due to increased investment in commercial and R&D growth drivers, and that achieving an ASP in the high $400s to $500 range could support gross margin in the low-to-mid 60% range given current cost performance.
On product development, Aballi said Exagen has five assets in development and is formalizing a cadence intended to launch one product each year. He highlighted myositis as a particularly requested clinical offering and said the company is conducting feasibility and validation work, with a goal to have a myositis offering “ready for the clinic” starting in 2027. Management also cited ongoing work in lupus nephritis and disease activity measures for SLE and RA, while emphasizing the need to refine reimbursement pathways before committing to timelines.
Aballi said Exagen expects to present seven abstracts at an International Autoimmune Conference in Prague and anticipates additional abstract presentations at ACR later in the year.
About Exagen (NASDAQ:XGN)
Exagen Inc is a molecular diagnostics company focused on improving the detection and management of autoimmune diseases. Headquartered in the United States, the company develops, manufactures and markets laboratory tests designed to help clinicians address diagnostic challenges associated with complex connective tissue disorders.
The company’s flagship product portfolio, marketed under the Avise® brand, includes multi-analyte assays such as the Avise® Connective Tissue Disease (CTD) panel, Avise® Lupus panel and Avise® Sjögren’s panel.
