Welcome, ladies and gentlemen, to the third quarter 2026 earnings conference call for Tactile Medical. At this time, all participants have been placed in a listen-only mode. At the end of the company's prepared remarks, we will conduct a question-and-answer session. Please note that this conference call is being recorded and will be available on the company's website for replay shortly. I would now like to turn the call over to Sam Bentzinger, Investor Relations at Gilmartin Group, for a few introductory comments. Please go ahead.
Good afternoon, and thank you for joining today's call. With me from Tactile Medical's management team are Sheri Dodd, Chief Executive Officer, and Elaine Birkemeyer, Chief Financial Officer. Before we begin, I'd like to remind everyone that our remarks and responses to your questions today may contain forward-looking statements that are based on the current expectations of management and involve inherent risks and uncertainties. These could cause actual results to differ materially from those indicated, including those identified in the risk factor section of our annual report on Form 10-K, as well as our most recent 10-Q filing to be filed with the Securities and Exchange Commission. Such factors may be updated from time- to- time in our filings with the SEC, which are available on our website. We undertake no obligation to publicly update or revise our forward-looking statements as a result of new information, future events, or otherwise.
This call will also include references to certain financial measures that are not calculated in accordance with generally accepted accounting principles, or GAAP. We generally refer to these as non-GAAP financial measures. Reconciliations of those non-GAAP financial measures to the most comparable measures calculated and presented in accordance with GAAP are available in the earnings press release on the investor relations portion of our website. With that, I'll now turn the call over to Sheri.
Thanks, Sam. Good afternoon, everyone, and welcome to our third quarter 2026 earnings call. Here with me is Elaine Birkemeyer, our Chief Financial Officer. We delivered total revenue of $91.9 million in Q3, led by a 13% year-over-year growth in lymphedema, marking our fifth consecutive quarter of above-market double-digit growth. This consistency demonstrates the durability of our leadership position and the substantial runway created by a market that remains significantly under-penetrated. Airway clearance revenue was $10 million, down year-over-year, as anticipated, due to the one-time DME inventory transition associated with the launch of our next-generation AffloVest system. The same DME customers we highlighted in Q2 continued to work through temporary excess inventory during Q3. There were no material changes in the underlying dynamics of the business, and we continue to expect airway clearance revenue to improve sequentially in the fourth quarter.
Across the portfolio, we continue to balance strong growth in our core lymphedema business with disciplined execution. Gross margin expanded 90 basis points year-over-year in Q3 to 76.7%, contributing to adjusted EBITDA of $14.3 million. This marks the 12th consecutive quarter of year-over-year gross margin expansion. Importantly, we have achieved this sustained improvement while continuing to invest in our product offerings to deliver greater value to patients and providers. Based on our year-to-date performance and our expectations for the fourth quarter, we are maintaining our full-year 2026 revenue guidance of $360 million to $366 million and raising our adjusted EBITDA guidance to $50 million to $52 million. This outlook reflects our continued confidence in low double-digit growth in our business and our expectation for sequential improvement in airway clearance revenue in the fourth quarter.
We expect full-year airway clearance revenue to decline mid to high single digits year-over-year. I will now turn a closer review of our lymphedema business line, including Q3 performance and recent progress against our three strategic priorities. Elaine will then review our financial results and the outlook for the remainder of the year. Lymphedema remains our core business and primary growth. Our Q3 results demonstrate our market leadership in both basic and advanced pneumatic compression devices, with revenue growing 13% year-over-year to $81.8 million. Sequentially, lymphedema revenue grew 11%, supported by a recovery from the Medicare ordering timing disruption associated with the April implementation of prior authorization requirements. As expected, the prior authorization process has stabilized as our teams and the MACs have gained experience with the new requirements, and we believe this timing disruption is now behind us.
Medicare revenue returned to growth in Q3 of 11% year-over-year. Beyond Medicare stabilization, the quarter's performance was driven by execution across several key drivers. Our go-to-market investments in sales reps and CRM technology are extending the reach and impact of our commercial organization. Clinic visits increased 19% year-over-year in the third quarter, and referring clinics grew more than 10% year- to- date. These results are enabled by enhanced market insights that help our teams identify and prioritize referral opportunities across our account base. Our clinician-focused marketing programs are also delivering measurable returns, with select events generating 20% to 45% order growth from participating accounts in the 90 days following the event compared to the 90 days prior. Through our medical education team, we have educated more than 13,000 clinicians who treat lymphedema patients so far in 2026, already 25% more than in all of 2025.
This expands the number of providers equipped to identify patients and refer them to appropriate therapy. Additionally, broader patient access to advanced pumps remains durable following our tighter alignment with the NCD policy, and this is reflected in our product mix. As part of the next phase of our go-to-market playbook, this quarter we established a dedicated strategic accounts team within our broader commercial organization. This team will focus on deepening engagement with larger health systems and IDNs while expanding referral opportunities within existing high-volume regional and national accounts. Taken together, these trends give us confidence in our ability to deliver sequential lymphedema growth in Q4. We are beginning to see benefits from investments in our operating model and order process, which are improving efficiency and service quality as patients move from referral to therapy.
The strong prior year comparison next quarter resulting from the initial benefit of our alignment with the NCD will moderate year-over-year growth, but does not change our confidence in the underlying momentum of the business. Looking beyond our third quarter results, we are executing well on our three strategic priorities designed to sustain double-digit growth: expanding access to care, creating value across the patient journey, and expanding treatment options. Together, these priorities form a compelling growth model, supporting performance today while strengthening the drivers for sustained lymphedema performance over time. As with most market development opportunities, growth starts with diagnosis. Patients must first be identified, diagnosed, and referred before we can help them access clinically appropriate therapy. Expanding access to care means helping more patients get diagnosed and referred into the care pathway.
A referral is only the beginning of the order process, and growth also requires pulling a higher percentage of referrals through to shipment. Today, not every diagnosed patient with lymphedema makes it through the documentation and order process necessary to receive therapy, and each patient lost along the way is a diagnosed patient who potentially goes underserved. Creating value across the patient journey is about closing the gap and converting more eligible referrals to shipments, which is where we serve the patient and how we generate revenue. Expanding treatment options supports every step of that pathway. A broader portfolio gives clinicians more solutions for their patients, supports more additional referral opportunities, and extends the patient populations and disease stages we can serve. As these capabilities scale, we also expect greater productivity and operating leverage to support Adjusted EBITDA growth over time.
Put simply, sustained growth in our lymphedema business is not solely a function of adding sales representatives. It comes from helping more patients get diagnosed and referred, supporting more of those referrals so they can reach therapy, and expanding the range of patients and therapy needs we can address. Our first priority is expanding access to care through earlier diagnosis and broader patient coverage. The opportunity is significant. An estimated 20 million people in the U.S. are living with undiagnosed lymphedema, and many diagnosed patients continue to face coverage barriers. Our LymphaTech 3D Scanner currently gives clinicians an FDA-cleared quantitative way to measure limb volume and circumference, supporting earlier and more consistent identification of the disease. We are encouraged that LymphaTech is currently in use and generating revenue at leading academic medical centers, even ahead of an established reimbursement pathway, demonstrating its utility in clinical practice.
We recently achieved an important regulatory milestone, receiving FDA 510(k) clearance for an expanded indication of the LymphaTech 3D Scanner. LymphaTech is now cleared to provide circumference and volume measurements to aid in the assessment of lymphedema. This expands LymphaTech's clinical positioning beyond measurement and surveillance alone, and this expanded indication strengthens the foundation for our broader diagnostic strategy, including our work on clinical adoption, reimbursement, and further integrated diagnostics. On LymphaTech 3D Scanner reimbursement, our application for a Category III CPT code was discussed during our Q2 earnings call and is scheduled for final review at the February 2027 meeting. While a Category III code is a tracking code rather than a coverage decision, it is an important step towards broader reimbursement.
Together, these regulatory milestones are intended to support wider adoption of LymphaTech, enabling earlier and more objective identification of lymphedema and monitoring of fluid over time, and ultimately helping bring more patients into the care pathway. We are also making progress in broadening payer access for patients who already have been diagnosed with lymphedema. Following publication of the six-month results from our randomized control trial of Flexitouch therapy for head and neck cancer-related lymphedema, we have begun to see movement among commercial payers, with a small number removing restrictive experimental and investigational designation from their policies. Significant work remains, but these early policy changes demonstrate that our clinical evidence and payer engagement can expand coverage over time, opening access to therapy for more eligible patients and supporting additional referral opportunities. Our second priority is creating value across the patient journey.
While we see opportunities to improve the experience at every stage of care, our current focus is on the highest impact stage of the journey, helping more eligible patients successfully start therapy. By reducing friction in the upfront documentation and order process, we can improve conversion from referral to shipment and ensure more patients receive the therapy prescribed by their clinician. This benefits patients, simplifies the experience for referring clinicians and their staff, and supports a more efficient and stable operating model. Ultimately, increasing access to therapy is a key driver of both patient value and sustainable growth. During the quarter, we made organizational and operating model changes to strengthen how orders move from referral to shipment. We also continue to re-platform our end-to-end order process through our AI-enabled order management platform and care navigation work.
Together, these efforts are designed to reduce friction, improve visibility into patient progression, and strengthen execution across the referral-to-shipment process. We are already seeing tangible results in medical record review, one step within the broader order process, where technology-enabled improvements have reduced average review time by approximately 50%. While meaningful work remains, this early result demonstrates the potential to improve service levels, increase capacity, and support future order growth more efficiently as we extend these capabilities across the end-to-end process. Building on this progress, we are taking another important step in the evolution of our operating model. As announced today, Steve Kiewiet is joining Tactile Medical as Chief Operating Officer. In this newly created role, Steve will lead our order operations and patient services teams, connecting capabilities that support a patient from referral through shipment into one operating organization.
This structure will enable more coordinated decision-making across the full journey and help us extend process improvements more broadly, creating a better experience, greater capacity, and a more scalable operating model. Steve brings breadth and depth of experience in revenue cycle management, field-based patient educators, call center, and DME operations. This is the right time to bring an executive-level enterprise operations leader to our team, and we are excited to have him on board. Our third priority is expanding treatment options. A broader innovation portfolio allows us to address more patient needs, support additional referral opportunities, and serve patients across a broader range of disease stages. We are advancing opportunities that complement our core pneumatic compression therapies and expand the patient populations we can address.
Consistent with our previously stated commitment, a significant milestone came in October when we filed a 510(k) application for Flexitouch Pro, a meaningful enhancement to our advanced pneumatic compression system. Flexitouch Pro is designed to improve the patient and clinician experience through usability and connectivity enhancements that simplify therapy administration while delivering the clinical effectiveness that has made Flexitouch the longstanding market leader. Subject to completion of the regulatory process, we are targeting a commercial launch of Flexitouch Pro in the second half of 2027. This innovation is intended to reinforce our leadership in advanced pneumatic compression and increase the value we deliver through our core franchise. We are also preparing to introduce MyoSleeve in the U.S. through our partnership with ElastiMed.
Our next milestone is a focused VA pilot beginning in late Q4, which will help us evaluate the patient experience, clinical fit, and appropriate go-to-market model before broader commercialization. MyoSleeve is not reflected in our 2026 guidance, and we expect its contribution to build gradually over time. Strategically, it represents an opportunity to serve additional patients and expand the range of therapy needs our portfolio can address. Overall, we remain confident in the durability of our lymphedema business and the opportunities ahead in 2027 and beyond. Each of our strategic priorities is at a different stage of development, and their impact will build over time. Collectively, they are designed to strengthen the fundamental drivers of our lymphedema business: more patients being identified and referred, more eligible patients receiving therapy, and a broader range of patients and care needs we can serve.
That is the growth model we believe can support durable revenue growth and improving profitability over time. With that, I'll turn the call over to Elaine to review our financial results and full-year outlook.
Thanks, Sheri. Unless noted otherwise, all references to third-quarter financial results are on a GAAP and year-over-year basis. Third-quarter total revenue was $91.9 million, up $6.1 million, or 7.1%, as double-digit growth in lymphedema more than offset the expected decline in airway clearance. By product line, revenue from our lymphedema products, including Flexitouch, Nimbl, and LymphaTech, increased $9.5 million, or 13.1%, to $81.8 million. Lymphedema growth was broad-based across payer channels, with Medicare revenue increasing approximately 11% and commercial revenue increasing approximately 17% year- over- year, while VA revenue was approximately flat. Revenue from our airway clearance product, AffloVest, decreased $3.4 million, or 25.1%, to $10 million, consistent with the DME inventory dynamics Sheri discussed earlier. Year-to-date, total revenue increased 12% to $252.8 million, led by 15% growth in lymphedema.
Moving down the P&L, gross margin expanded to 76.7% of revenue from 75.8% in the third quarter of 2025. The increase primarily reflected lower manufacturing costs and favorable product mix, and was consistent with the expectations embedded in our full-year outlook. Third-quarter operating expenses increased $6.9 million, or 12.7%, to $60.9 million. The increase primarily reflected the annualization of prior year sales force hiring and continued investment in technology and other capabilities supporting our growth. These investments are directed at the growth drivers Sheri outlined, generating referrals, converting more referrals to shipment, and expanding our portfolio.
By expense category, the increase in operating expenses reflected a $3.2 million increase in sales and marketing expenses, a $0.3 million increase in research and development expenses, a $3.2 million increase in Reimbursement, general and administrative expenses, and a $0.1 million increase in intangible asset amortization and contingent consideration. Operating income was $9.6 million compared with $11 million in the prior year period. Net interest income was $0.5 million, consistent with the prior year period. Income tax expense was $3 million compared to $3.2 million in the prior year period. Net income was $7.2 million, or $0.31 per diluted share, compared with $8.2 million, or $0.36 per diluted share, in the third quarter of 2025.
Adjusted EBITDA was $14.3 million compared to $14.4 million in the prior year period, and adjusted EBITDA margin was 15.6% compared to 16.8%. Gross margin improved 90 basis points, while higher operating expenses, including the annualization of prior year sales force hiring and continued investment in technology and operating capabilities, more than offset that improvement. Year-to-date adjusted EBITDA has increased approximately 35% to $29.5 million, and we continue to expect adjusted EBITDA growth for the full year. Over time, as our investments mature and scale, we expect operating expenses to grow more slowly than revenue, supporting operating leverage and adjusted EBITDA growth. On the balance sheet, we ended the quarter with $75.1 million in cash and no outstanding borrowings, up from $69.9 million at the end of the second quarter.
During the third quarter, we generated $12 million in operating cash flow, which more than funded approximately $6.2 million in share repurchases. As of September 30th, 2026, approximately $12.5 million remained available under our $25 million share repurchase program. Our capital allocation priorities are unchanged. We will continue to invest in the commercial, operational, and strategic capabilities that support organic growth, preserve capacity for disciplined M&A, and repurchase shares when we believe valuation is attractive and doing so does not constrain our strategic priorities. Now, turning to our outlook. As Sheri mentioned, we are maintaining our full year 2026 revenue guidance of $360 million to $366 million, representing growth of approximately 9%-11% year-over-year. Stronger lymphedema performance is offsetting a lower airway clearance outlook. In lymphedema, we continue to expect low double-digit growth for the full year.
For the fourth quarter, we expect meaningful sequential growth with a moderation in year-over-year growth compared to recent quarters, as we lap a particularly strong fourth quarter of 2025 when lymphedema grew 16% on the initial benefit of NCD alignment. In airway clearance, we now expect full year revenue to decline in the mid to high single digits compared with our prior expectation of approximately flat. DME customers are taking longer than we initially expected to work through existing inventory as they transition to the next generation AffloVest, so we now assume a more gradual normalization of ordering. This reflects ordering timing, not a change in patient demand or market leadership. We expect sequential improvement in the fourth quarter, with revenue remaining below the prior year, consistent with our full year outlook.
Our total revenue range mainly reflects the timing of lymphedema referrals converting to shipments in the fourth quarter, our seasonally largest quarter. For modeling purposes, we expect the following for the full year: GAAP gross margin of approximately 76.5%, GAAP operating expense growth of 10%-12%, net interest income of approximately $2.4 million, an effective tax rate of approximately 28%, and fully diluted weighted average shares outstanding of approximately 23 million. We are raising our full year 2026 EBITDA guidance to $50 million-$52 million, representing growth of approximately 12%-16% compared with $44.8 million in 2025.
Our adjusted EBITDA expectation includes the following adjustments: stock-based compensation expense of approximately $8.6 million, depreciation and amortization expense of approximately $7.3 million, executive transition costs of approximately $1.3 million, acquisition-related and integration costs of approximately $1.3 million, and litigation-related costs of approximately $1 million. With that, I'll turn the call back to Sheri for some closing remarks. Sheri?
Thanks, Elaine. To close, this quarter reinforced the strength and durability of our core lymphedema business. We delivered another quarter of double-digit lymphedema growth, expanded gross margins, and generated strong cash flow while investing in the capabilities that can support our next phase of growth. Our opportunity extends well beyond the patients we serve today. By helping more patients get diagnosed and referred, converting more of those referrals to shipments, and broadening the range of patients and therapy needs we can serve, we believe we can continue to expand the market we serve and increase the value we create along the patient journey. At the same time, we remain focused on translating that growth into greater operating leverage over time.
Our revenue guidance reflects our year-to-date performance and expectations for the remainder of the year, while our adjusted EBITDA guidance demonstrates continued financial discipline as we invest to support long-term growth. We believe Tactile is well-positioned to deliver durable growth, expand operating leverage, and long-term value for our shareholders. Finally, I'd like to thank our Tactile Medical employees for their continued commitment to our patients, our clinical customers, and one another. With that, operator, we'll now open the call for questions.
Thank you. We will now be conducting a question-and-answer session. If you would like to ask a question, please press star one on your telephone keypad. A confirmation tone will indicate your line is in the question queue. You may press star two if you would like to remove your question from the queue. For participants using speaker equipment, it may be necessary to pick up your handset before pressing the star keys. Our first question will come from Ryan Zimmerman with BTIG.
Good evening, Sheri and Elaine. Elaine, congrats. The profitability, you have the company in such good fighting shape. Just wanted to mention that. If I could ask a little bit about 2027. I know it's early, and we're not going to get guidance, but first, as we think about any puts and takes, particularly with the airway clearance business normalizing, wanted to get your thoughts around that. Two, to ask in another way, is there any reason why the lymphedema market would change or slow down, or your position and growth would be impacted in any capacity? As I think about both the contributions from, say, Flexitouch Pro, you have the ElastiMed contributions coming in in 2027, you potentially have benefits from LymphaTech. It would seem that there should be some acceleration in the business, particularly on the lymphedema side. Thank you. I know it's a lot.
Hi, Ryan. We're smiling here, and thanks for the shout-out on the profitability piece. Definitely a lot of work has been done on that side, and appreciate you acknowledging that. I'm going to start with the last point first on the lymphedema business. We don't see any reason why there should be a slowdown. In fact, the byproduct of more market awareness with the diagnostic coming into play, with the continued, hopefully, favorable policies that support right patient, right pump at the right time. Certainly from our standpoint, our operating model and our footprint in the field, we believe that this is not a disease area or category, or even from our business, that would see a slowdown. So, we're feeling very good about lymphedema as a core growth driver for our business and the market to be super favorable in that area.
Your question about 2027, so we're not going to be putting any specific guides on 2027, but lymphedema business, we're feeling very confident in the durable growth, what you've seen over the past five consecutive quarters of the double-digit growth, 13% in this quarter alone. Then for the AffloVest, as we've said, the inventory pacing is going to be a little bit different in Q4. We are going to see a sequential growth from Q3 to Q4. It's going to be a bit more moderated than what we had talked about in Q2, as we've learned a little bit more about what's happening so far. But we believe that business will step back into what is going to be a good business, and we'll be able to participate with the product that we have, our next-generation AffloVest product, which remains the only untethered vest.
It's still the lightest vest. It's a connected vest, and continues to provide great value to patients. So, without giving any guide on 2027, hopefully that kind of gives you a flavor of how we're thinking about it.
Very helpful. Flexitouch Pro, any considerations that we need to be thinking about, whether from a price or a margin standpoint, as you introduce that to the market? I know you talked about some of the benefits maybe qualitatively, but just any quantitative considerations are helpful. Thank you. Thanks for taking the questions.
Yeah, you bet. Flexitouch Pro will fall as an E0652, so that reimbursement will be what it currently is, and whether we expect that to be for next year, which is usually increased at the same rate of COLA. There won't be any upside or anything different from what is actually the reimbursement from the code standpoint. From an internal standpoint, gross margins will be in the zip code of our current products.
Thank you.
Of the current Flexitouch portfolio.
Our next question will come from Adam Maeder with Piper Sandler.
Hi, this is Kyle on for Adam. Thanks for taking the question. I might just push my luck here again with a 2027 question. I know you're not providing guidance at this time, but from a P&L standpoint, 2025 was an investment year. 2026, there were a lot of investments made as well, while you were also still able to show some good EBITDA growth in both years. Just curious, maybe just at a high level qualitatively, how are you thinking about that for next year? Should we expect to kind of continue to see some leverage while also still investing in growth? Anything around that could be helpful. Thanks.
Yes. Thanks for the question. So, we have committed to operating leverage, and that is our commitment, and we'll continue to see that into next year. This year, of course, we had some annualization of the sales rep head, and we continue to invest in our business, both in terms of the transformational platform for our order operations, and those investments will continue into 2028. But we expect to see ongoing leverage, and that is our goal, to both grow top line as well as bottom line. From a revenue perspective, and as I shared with my comments with Ryan, there's nothing that says anything is going to be going down, that's going to be pulling, or the market becomes less attractive.
There is a reality that there is a large proportion of patients that are underserved, and there's no automatic button that allows suddenly a whole bolus of patients to get diagnosed, even though we have the 3D Scanner in our portfolio. There's a lot that needs to happen in order for these patients to get diagnosed. They still have to have the documentation. They still have to see their physician. So, we believe that there is a healthy market there, but I also want to temper some expectations that there isn't just a sudden hockey stick that happens, because now we'll have the Flexitouch Pro and the 3D Scanner. Takes time, it's chipping, but we are in the best position to be able to demonstrate some durable, sustainable growth in a way that is going to return value to shareholders.
Great. That's helpful.
Does that answer your question, Ryan?
Yeah, it did. That was great. Maybe just as a quick follow-up, congrats on the head and neck progress with payers. Just wanted to ask if you're willing to quantify how many wins you saw in removing some of that restrictive language. Similarly, is there anything you could quantify in terms of when we could see some gradual revenue contribution from that population, or just kind of how you expect that to unfold with those payer wins?
Yeah. Consistent to what we shared before, I wish I had a different story here, but the nature of overturning and changing commercial policies has to be based on evidence and being kind of share of mind for the payers. We're not going to quantify or kind of call out the specific payers, but we did see some of those policies change that now have moved from E&I into covered. That gives us confidence that the evidence is resonating, that payers are willing to change their policies, and then it's just kind of a block and tackle, block and tackle all the way down of getting that to change. That also takes some time, and we'll build what we believe to be that pace into our 2027 revenue, but it won't be a hockey stick either.
But the good news is more patients are going to get access to the only available therapy, compression pump therapy, for the head and neck area post them surviving head and neck cancer. So, it's an important technology advance and important population, and we're continuing to work really hard to make those policies change.
That's helpful. Thank you.
We'll go next to Brandon Vazquez with William Blair.
Hey, Sheri. Hey, Elaine. Thanks for the question. I wanted to ask first on AffloVest. Can you just talk a little bit about, you made a comment that rebuilding inventory has been taking a little longer than you would have expected. Just talk a little bit about the visibility that you actually have on the sell-through of AffloVest, and maybe why the rebuilding of inventory is taking a little longer, and the confidence you have that we're at the trough here on inventory.
Yeah. Thanks, Brandon. So, Q3 AffloVest delivered on expectations, and we gave our guidance at a time based on what we saw. As we've gotten into Q4, we are seeing that pace of burning through the inventory being a little bit slower than we had forecasted when we last spoke to you. That is reflected in our current earnings, as we've demonstrated here. What's behind it is, again, there's no new DMEs that suddenly have said, we have an inventory. It's the same DMEs that we identified in Q2. Depending on where that inventory is held, sometimes it's in the individual branches, and sometimes it's central, but it can be different.
While we do not have real-time visibility into every location, we do know that because this is so concentrated with a few of our customers, that when their timing is off, it actually can impact our quarter. So, that is why we are being prudent, and we are giving the guidance specifically on Afflo, and we are calling as we see it, which is a slight slowdown. What we do know is that there is no change in the underlying patient demand, the therapy effectiveness, or competition. So, those things remain true. It is just this pace. In our indirect business model, those are not things that I can impact directly. What we can do, again, is having great therapy, continue to train, continue to help the DMEs and support the work that they are doing.
But this pace is something that really is not something I can directly control, and we are calling it as we see it right now.
Okay. Thanks. Then on the lymphedema side, you guys had given a metric I do not think we get too often, which is that the referring clinics were up 10% year- to- date. I was curious if you could kind of talk a little bit about how does that number historically trend? Is this kind of a good predictor for you guys as you look forward into future growth? What type of accounts are new into the referral network? Are they different what they have historically been? Just any more commentary around that. I thought it was a good, interesting metric on the success you guys are seeing there on referrals. Just curious if we could get more color on how it is developing and might impact the business. Thanks.
Yeah. This is not probably something we are going to update every time, but when we were reflecting on what we could share, we thought it would be good to put a little more quantification around what that rep productivity is actually really looking like. So, there are two aspects, right? So we have more feet on the street, and then we talked about the rep productivity being enhanced by the CRM tool. Additionally, we have this overlay of market data that really helps the rep identify where are patients being diagnosed, and are they in the clinics they are currently calling on, or maybe they are in clinics that are outside of the current call point. So that enhanced market insights really help our teams identify and prioritize the referral opportunities.
So literally, more feet on the street and better tools. While the insights are not real-time, they are lagging three to six months, it is still good data. That is why we are seeing this really nice uptick on that year-over-year in clinic visits. Then looking at, as well as I gave some metrics on just on our marketing programs, actually showing the 90-day pre and the 90-day post, what that actually does to help drive order growth. Our investments in sales and marketing, when we look at metrics like this, then sharing a few of them with you, hope to, you are seeing the value of the investments that we made in 2025 and where our dollars continue to go in 2026.
As a final reminder, that is star one if you would like to ask a question. We will go next to Ben Haynor with Lake Street Capital Markets.
Good evening. Thanks for taking the questions. First off for me, just on airway clearance and the DMEs that presumably some of them have worked through any inventory issues. Can you talk any about what you are seeing from those that do not have the inventory situation?
Sure. When we look at our small handful of them have inventory issues, and they are burning through that. On those that did not have excess inventory, and they went in and are currently selling Gen 6, what we are hearing is really strong feedback from both clinicians and patients on the product. That appears to be going well, and we continue to help, like we do even for those that have the excess inventory, help those DMEs, help identify the patients that have bronchiectasis that have not been put on treatment yet. That all is going as it is going.
What I want to caution, though, is even though that adoption of the Gen 6 is good, in the small handful of those that are still burning through their excess inventory, our forecasting for Q4 is reflecting both health in those that don't have inventory issues as well as the burden in those that do. Ben, to be honest, we just can't overcome the slowdown in the excess inventory burn with performance in the other DMEs. They're performing well, but they can't overcome, if you will, the slowdown with those that have the excess inventory.
Okay. That's helpful color. Then, dipping my toe into 2027, anything you can tell us on expectations for what the kind of the field sales force looks like, as we get into or exit next year?
You know what? We're super excited to be basically activating our playbook. When I say excited about that, because it's one thing to say you have a playbook, it's another thing to actually use it. We are on, I think, part six of our go-to-market playbook, which the basis of it is when territories get bigger, then we will split territories. Then splitting that territory, we will put in place both a, what we call a territory account manager as well as that product specialist. So every time you split, you put two more in. As we look at territory performance, we'll be looking at splitting, and some of those maybe that be underperforming, there could be some consolidation. But nothing dramatic is going to happen here. Just we'll run it like we said we were going to run it.
The one difference, and I call this out in the script, is that we did stand up a strategic accounts function. Strategic accounts function, I think, is a natural evolution of any field commercial organization when there is national accounts, those accounts that are starting to be kind of high volume. How do you have a differentiated offering and more of a key account manager that helping to support both the programs and the relationships? So, standing that up, just this past quarter, we won't see any revenue tied to that in Q4, but we definitely would expect strong revenue performance in going into 2027, in line with the realities that I mentioned before. You want to have that connectivity to the strategic account, but it doesn't suddenly, all of a sudden, open up thousands and thousands and thousands of referrals that start coming through in a fast clip.
But it's just a maturing of our organization, and strategic accounts is a really good first step for us.
Okay. That makes sense. Lastly for me on the LymphaTech clearance, congrats on that. I believe you're monetizing that via a SaaS model at the moment. If you do get that Category I code down the line, do you intend to stick with the SaaS model, or is this something where it could be a click fee, or any thoughts that you care to share on how that ultimately gets monetized?
We are still taking a look at that full business model. Pleased that right now the 3D Scanner currently has a couple of large academic centers that are paying for it as a SaaS model. CPT 3, the coding, it just starts as a tracking code, and you have to build over time. So we're in early stages of building out that reimbursement pathway. Then we'll be taking and are currently taking, and we can reveal more of that next year, what that actual business model looks like. So we're pleased to get the approval, obviously, of the expanded indication. That's the first step. The category three code, that becomes the next step, and then moving on to actually seeing full gear of commercialization, which we'll be seeing later in 2029.
It's a little bit down the line, but thanks for the thoughts there. Congrats on the quarter. Thanks for taking the questions.
Thank you. Thanks, Ben.
This now concludes our question and answer session. I would like to turn the floor back over to Sheri Dodd for closing comments.
Thanks, Chris. I just want to thank everyone for your thoughtful questions. Pleased that we were able to deliver again against our core business, that 13% growth in lymphedema, and deliver on what we said we were going to do. We managed the AffloVest kind of shortfall with that strength of lymphedema, and are really pleased to be able to keep our guide for the year and increase our pull-up on our EBITDA guide as we finish out the year. So, thanks to you, and we'll look forward to having the one-on-one conversations. For everyone else, we'll see you next quarter.
Ladies and gentlemen, thank you for your participation. This does conclude today's teleconference. You may disconnect your lines, and have a wonderful day.