Billiontoone (NASDAQ:BLLN) reported fourth-quarter and full-year 2025 results that company leaders said reflected rapid growth, expanding margins, and continued investment in product development and market access. Management also raised its 2026 revenue outlook and pointed to multiple potential catalysts in both prenatal and oncology testing.
2025 results highlighted “rule of 100” performance
Co-founder and CEO Ozan Ateş said the company delivered 100% year-over-year revenue growth in 2025 with a 13% adjusted EBITDA margin, positive GAAP operating margin, and positive cash flow. Ateş attributed the performance to increases in test volumes and average selling prices (ASPs), along with lower costs and productivity gains driven by automation and AI.
Fourth-quarter revenue more than doubled; profitability improved
Total revenue in the fourth quarter of 2025 was $96.1 million, up 113% from $45.1 million in the prior-year quarter, Taylor said. Prenatal revenue increased 98% year over year to $86.9 million, including $86.1 million in clinical testing revenue and $0.8 million from clinical trial support and other services. Oncology revenue rose 736% to $9.1 million.
The company recorded $8.4 million of “true-up” revenue in the quarter, up from $1.1 million a year earlier, reflecting higher cash collection trends on tests delivered in prior periods. Taylor said fourth-quarter revenue exceeded the company’s December guidance range of $84 million to $90 million, with about two-thirds of the upside driven by higher-than-expected test volumes and one-third driven by higher true-up revenue.
Gross profit was $68.6 million, compared with $25.7 million in the prior-year quarter, and gross margin expanded to 71.4% from 57%. Operating expenses were $58.3 million, up 56% year over year, including R&D expense of $14.3 million and SG&A expense of $44.0 million. Operating income was $10.3 million versus an operating loss of $11.7 million a year earlier, producing an 11% operating margin.
Net income available to common shareholders was $4.4 million, or $0.11 per diluted share, compared with a net loss of $11.5 million, or $1.13 per diluted share, in the fourth quarter of 2024.
Product updates and clinical momentum in prenatal and oncology
Ateş highlighted multiple product launches and clinical and reimbursement milestones. In prenatal testing, he said UNITY’s fetal antigen non-invasive prenatal testing (NIPT) has begun changing standard of care in alloimmunized pregnancies, pointing to a clinical practice guideline published in November recommending the use of cell-free fetal DNA to determine fetal red blood cell antigen status after 10 weeks gestational age.
At the Society for Maternal-Fetal Medicine (SMFM) conference in February, the company announced a dual launch: expanded red blood cell fetal antigen NIPT and what it described as the first and only platelet fetal antigen NIPT. Ateş said the expanded offering covers 99% of antigens associated with hemolytic disease of the fetus and newborn (HDFN) and that the platelet incompatibility test addresses fetal and neonatal alloimmune thrombocytopenia (FNAIT). These tests are available through UNITY Aneuploidy Screen without an additional order or blood draw, according to management.
In oncology, the company launched Northstar PGx (pharmacogenomics) and Northstar Select CH (clonal hematopoiesis) as add-ons to Northstar Select. Ateş said Northstar Select CH combines targeted white blood cell sequencing for guideline-recommended genes with proprietary machine learning classification for other genes, and he cited “greater than 99% accuracy” in distinguishing tumor-derived alterations from non-tumor findings. Management said these add-ons are integrated into the same report and maintain the same average turnaround time.
Separately, Ateş said the company submitted a Northstar Response coverage dossier to MolDx spanning five studies and three peer-reviewed publications, positioning it as a step toward securing MolDx coverage. In Q&A, he said MolDx already covers the concept of treatment monitoring under an existing policy and that management is planning for a coverage decision “for the end of the year.”
Market access: Medicare coverage, payer contracting, and UnitedHealthcare in-network deal
Ateş said the company obtained Medicare coverage for Northstar Select and signed 44 payer contracts in 2025, adding more than 25 million lives and reaching 250 million contracted lives in the U.S. He also cited ASP tailwinds from Medicaid adoption of the carrier panel PLA code 0449U, noting that it was added to 10 Medicaid programs in 2025, with Florida starting to cover 0449U in the first quarter of 2026.
One of the most notable updates was a newly signed in-network contract with UnitedHealthcare. Ateş called the agreement a “landmark moment,” arguing that in-network status reduces friction for physicians and patients and can improve predictability of reimbursement. Responding to a question about potential price discounts, Ateş said the company expects higher ASPs going forward and stated that, over roughly 200 contracts signed in the last four years, “not a single one decreased our ASPs.” He added that payer contracts typically cover both prenatal and oncology offerings, though payment depends on coding and coverage.
2026 guidance raised; management cites additional catalysts not embedded in outlook
Taylor raised 2026 total revenue guidance to $430 million to $445 million, representing 41% to 46% growth from 2025, and said the company continues to expect positive GAAP operating income for the full year. The new range is $15 million higher at both ends than the company’s earlier January outlook of $415 million to $430 million.
In Q&A, management said the 2026 revenue guide does not include true-up revenue. Taylor also cautioned against assuming meaningful gross margin expansion, saying he would expect margins to remain in a high-60% to low-70% range.
Ateş described several potential upside drivers that he said are not reflected in guidance, including health system adoption tied to maternal-fetal medicine (MFM) decision-making and future EMR integrations. He said health systems could represent roughly 10,000 to 30,000 tests per year each, but that timing depends on integration work and other stakeholders. He also said the UnitedHealthcare agreement is effective April 1 and that the company did not incorporate incremental upside from the contract into its revenue guidance.
On sales force expansion, Ateş said prenatal sales reps are expected to grow from roughly 150 to 185 by year-end 2026, and oncology sales reps from roughly 45 to 65 by year-end, describing the pace as a deliberate approach to maintain turnaround time and service quality while balancing growth with GAAP profitability.
About Billiontoone (NASDAQ:BLLN)
BillionToOne (NASDAQ: BLLN) is a molecular diagnostics company that develops and commercializes high-precision genetic testing solutions based on single-molecule counting technology. The company’s platform is designed to detect and quantify rare genetic variants and chromosomal abnormalities from cell-free DNA, with a primary focus on applications in prenatal screening and other clinical genetic tests where sensitivity and specificity at very low allele fractions are critical.
BillionToOne’s offerings center on assay development and clinical testing workflows that enable non-invasive prenatal testing (NIPT) and targeted molecular diagnostics.
