MiMedx Group (NASDAQ:MDXG) reported fourth-quarter and full-year 2025 results that management said topped internal expectations, supported by strong growth in both its wound care and surgical segments. On the company’s earnings call, executives also focused heavily on disruption in the wound care market following changes to Medicare reimbursement for skin substitutes that took effect Jan. 1, and they outlined financial expectations for 2026 amid what they characterized as a transition year.
Record 2025 results and Q4 performance
Chief Executive Officer Joe Capper said MiMedx delivered record highs for full-year revenue and adjusted EBITDA, helping lift the company’s net cash balance to nearly $150 million at year-end. For the fourth quarter, MiMedx posted net sales of $118 million, representing 27% year-over-year growth, with both wound care and surgical segments growing at or above 25%.
For profitability, Rice reported fourth-quarter GAAP gross margin of 84% versus 82% a year earlier. Excluding acquisition-related amortization expense, adjusted gross margin was 86%, up about 200 basis points, primarily due to product mix. Adjusted EBITDA for the quarter was $29 million, or 25% of net sales.
MiMedx ended 2025 with a net cash position of $148 million. Rice said the business generated $25 million in free cash flow in the fourth quarter, and Capper noted net cash rose $24 million sequentially in the quarter and increased by $63 million over the course of 2025.
On a full-year basis, Rice said MiMedx delivered:
- $419 million in net sales, up 20% versus 2024
- GAAP net income of $49 million
- Nearly $106 million in adjusted EBITDA, representing an adjusted EBITDA margin of over 25%
Wound care faces Medicare reimbursement disruption
Capper said the wound care market is experiencing disruption after the recalibration of the Medicare reimbursement rate for skin substitutes, which went into effect Jan. 1. He described market adjustments that include slowed claims processing in states participating in the WISeR model due to prior authorization requirements, increased audits and callbacks, “dumping” of products at very low prices, and some providers shutting down their businesses.
In the question-and-answer session, Capper said the company anticipated significant disruption from the fourth quarter into the first quarter, and he acknowledged “a pretty significant drop-off” moving from Q4 to Q1. He also said January and February are typically slower months due to deductible season, and he noted that in a typical first quarter, more than 40% of revenue comes in March.
Despite near-term disruption, Capper said wound care remains a profit center for MiMedx even at lower reimbursement rates, and he expressed confidence the company is positioned to “flourish” as the market resets. He also said MiMedx believes CMS may ultimately require proof of efficacy for products it reimburses and that speculation includes a potential move to a National Coverage Determination rather than local coverage determinations. Capper argued that would favor MiMedx due to its investment in clinical research.
Clinical trials and complementary wound offerings
Capper said MiMedx’s EPIEFFECT randomized controlled trial is nearly fully enrolled, with a final readout expected in “a few months,” followed by publications. Rice added management expects a full readout and publication later in 2026. The company also said it has committed to running an RCT for CHORIOFIX, a dual-layer chorion membrane allograft in development. Rice described CHORIOFIX as a lyophilized human placental allograft that includes two layers of chorion with an attached intermediate layer.
Capper also highlighted a distribution agreement with RegenLab to commercialize RegenKit-Wound Gel, a PRP system intended to provide clinicians an alternative modality for treating chronic wounds. He said early feedback has been favorable, and in Q&A he noted the PRP product launch is being “widely accepted” as providers consider other modalities.
Surgical segment momentum and portfolio expansion
Management repeatedly pointed to strength in the surgical segment. Capper said the surgical business grew 20% for full-year 2025 and 25% in the fourth quarter, and he said momentum continued into the new year. He also said MiMedx realigned its commercial team at the outset of the year to dedicate more sales professionals to surgical and expects to continue looking for ways to augment the team.
Capper discussed the launch of AMNIOFIX Thyroid Shield, a variant of AMNIOFIX intended as a protective barrier during thyroidectomy surgery. He described risks associated with thyroid surgery, including potential injury to the recurrent laryngeal nerve and parathyroid glands, and said evidence shows AMNIOFIX Thyroid Shield can reduce postoperative complications and support recovery of vocal and swallowing function and parathyroid function.
MiMedx also licensed commercial rights to three additional 510(k)-cleared products with surgical applications: NovaForm Wound Matrix, G4Derm Plus, and Hydrelix Collagen Matrix. Capper said NovaForm is the company’s first non-human derived sheet product. He added that the company continues to invest in research, pointing to a published article in the Journal of Inflammation that found DHACAM and LHACAM allografts exhibited immunomodulatory properties that correspond with beneficial outcomes observed clinically.
2026 guidance, margin expectations, and capital allocation
For 2026, Capper said MiMedx’s “best current estimate” for full-year revenue is $340 million to $360 million, with the lowest quarterly revenue expected in Q1 and “substantial increases” in each successive quarter as the market adjusts. He said the company anticipates full-year adjusted EBITDA to be in the mid-to-high teens. Rice said gross margin is expected to be in the mid-to-upper 70s in 2026 due to lower wound average selling prices and, to a lesser extent, lower gross margins from new products.
Capper also offered a longer-term view, saying the company expects to return to “double digit above market” top-line growth in 2027 with the margin profile produced in recent years prior to any acquisitions.
On capital allocation, Capper and Rice said M&A remains a priority, but the company has been disciplined and, as a result, has accumulated cash. The board authorized a share repurchase program for up to $100 million over the next two years, which management described as an option if MiMedx is unable to find accretive investments meeting its criteria.
About MiMedx Group (NASDAQ:MDXG)
MiMedx Group, Inc is a biopharmaceutical company focused on the development, manufacture and marketing of regenerative biomaterial products derived from human placental tissues. The company’s core mission centers on harnessing the extracellular matrix and growth factors within amniotic and chorionic membranes to support wound healing and surgical applications. MiMedx’s product line leverages proprietary purification processes designed to retain native tissue properties while ensuring sterility and safety.
MiMedx’s principal offerings include amnion/chorion allografts branded under names such as EpiFix® and AmnioFix®, which are indicated for the treatment of acute and chronic wounds—including diabetic foot ulcers, venous leg ulcers and surgical site repair.
