Carlsmed, Inc. (CARL) AI Stock Analysis

• Market Cap: $306.08M
• Dividend Yield: N/A
• Average Volume (3M): 83.49K
• Price to Earnings (P/E): ―
• Beta (1Y): 2.96
• Revenue Growth: 102.57%
• EPS Growth: -5.76%
• Country: US
• Employees: 100
• Sector: Healthcare
• Sector Strength: 45
• Industry: Medical - Healthcare Information Services
• EPS (TTM): -0.40
• Shares Outstanding: 26,592,909
• 10 Day Avg. Volume: 85,083
• 30 Day Avg. Volume: 83,493
• PEG Ratio: 0.15
• Price to Book (P/B): -3.40
• Price to Sales (P/S): 8.84
• P/FCF Ratio: -9.36
• Enterprise Value/Market Cap: 0.66
• Enterprise Value/Revenue: 4.52
• Enterprise Value/Gross Profit: 6.05
• Enterprise Value/Ebitda: -8.42
• 1Y Price Target: $20.00
• Price Target Upside: 73.76% Upside
• Rating Consensus: Strong Buy
• Number of Analyst Covering: 5
• EPS Forecast (FY): -1.64
• Revenue Forecast (FY): $70.30M

• Rating: 47 Neutral
• Price Target: $12.00 ▲(4.26% Upside)

The score is held down primarily by weak financial stability (negative equity), ongoing losses, and continued cash burn, despite rapid revenue growth. Technicals are moderately supportive with the stock trading above key moving averages, while valuation is constrained by negative earnings. The credit facility amendment is a modest positive for liquidity but does not fully offset the underlying balance-sheet and profitability risks.

Positive Factors

Revenue Growth

Sustained, very strong top-line growth indicates rapid adoption or market expansion for Carlsmed's spinal surgical products. Durable revenue momentum provides a larger base to absorb fixed costs, supports scale benefits, and underpins potential margin improvement and investment capacity over the next several quarters.

High Gross Margin

A 73.8% gross margin reflects strong product economics and pricing power for Carlsmed's surgical implants and guides. High gross margins are a durable structural advantage, giving room to cover R&D and SG&A and enabling faster path to operating profitability as revenues scale.

Improving Cash Generation

A large improvement in free cash flow growth signals improving operational cash conversion despite negative absolute levels. This trend suggests management is beginning to extract cash from growth, reducing future financing dependency if the improvement continues, and enhancing medium-term liquidity prospects.

Negative Factors

Negative Equity / Solvency Risk

Negative stockholders' equity is a structural red flag that weakens the company's financial resilience. It limits borrowing capacity, raises refinancing and covenant risks, and can restrict strategic flexibility, making long-term investment and growth funding more challenging without external capital or materially improved cash flows.

Ongoing Losses and Negative Margins

Persisting negative operating and EBITDA margins mean Carlsmed has yet to convert strong revenue growth into operating profitability. High operating expenses are offsetting gross margin benefits, prolonging the time to sustainable profits and increasing reliance on financing until cost structure or scale dynamics improve.

Negative Operating and Free Cash Flow

Continued negative operating and free cash flows represent an ongoing cash burn that can erode runway absent further financing or rapid margin gains. Even with FCF growth, persistent negative cash flow increases refinancing needs and elevates execution risk for product commercialization and commercial expansion.

Carlsmed, Inc. Business Overview & Revenue Model

Company Description

Carlsmed, Inc. develops and operates a surgical platform for the treatment of complex adult spinal deformities that enables surgeons to harness clinical intelligence, advanced image recognition, and 3D printing technologies. Its product includes aprevo, a medical platform that makes surgical plans and devices tailored to the precise medical situation of every individual patient. It provides New Technology Add-On Payment (NTAP) reimbursement. The company was incorporated in 2018 and is based in Carlsbad, California.

How the Company Makes Money

Carlsmed generates revenue primarily through the sale of its surgical products, including customized spinal implants and surgical guides. The company's revenue model is based on direct sales to hospitals and surgical centers, where its products are utilized in orthopedic surgeries. Additionally, Carlsmed may engage in partnerships with healthcare providers and surgical device distributors, which can enhance market reach and facilitate sales. The company could also explore licensing agreements or collaborations for joint product development, contributing to its income streams. Overall, the combination of product sales and strategic partnerships is key to Carlsmed's financial performance.

Carlsmed, Inc. Financial Statement Overview

Summary

Despite very strong revenue growth and a healthy gross margin, financial quality is weak due to ongoing net losses, negative operating cash flow/free cash flow, and a balance sheet with negative stockholders’ equity that raises solvency risk.

Income Statement

Carlsmed, Inc. demonstrated significant revenue growth of 434.11% year-over-year, indicating strong market demand or expansion. However, the company is facing profitability challenges, with negative EBIT and EBITDA margins, and a net loss. The gross profit margin is healthy at 73.81%, but the high operating expenses are impacting overall profitability.

Balance Sheet

The balance sheet reveals a concerning financial structure with negative stockholders' equity, indicating potential solvency issues. The debt-to-equity ratio is not calculable due to negative equity, but the company has a high level of debt relative to its assets. The equity ratio is negative, reflecting a reliance on debt financing.

Cash Flow

Carlsmed, Inc. shows a substantial increase in free cash flow, with a growth rate of 243.64%, suggesting improved cash generation capabilities. However, both operating and free cash flows remain negative, indicating ongoing cash burn and potential liquidity challenges. The ratios of cash flow to net income are not favorable due to negative net income.

Breakdown	TTM	Dec 2024	Dec 2024	Dec 2023
Income Statement
Total Revenue	44.75M	―	27.16M	13.78M
Gross Profit	33.46M	―	20.05M	9.90M
EBITDA	-24.04M	―	-22.79M	-18.12M
Net Income	-25.74M	―	-24.26M	-18.90M
Balance Sheet
Total Assets	134.86M	―	51.82M	14.02M
Cash, Cash Equivalents and Short-Term Investments	115.37M	―	40.13M	7.22M
Total Debt	17.61M	―	17.18M	11.39M
Total Liabilities	28.20M	―	122.45M	60.15M
Stockholders Equity	106.66M	―	-70.63M	-46.13M
Cash Flow
Free Cash Flow	-29.05M	―	-25.65M	-17.61M
Operating Cash Flow	-27.86M	―	-25.47M	-17.48M
Investing Cash Flow	-1.31M	―	-180.00K	-135.00K
Financing Cash Flow	100.11M	―	58.50M	3.18M

Carlsmed, Inc. Peers Comparison

Name	Overall Rating	Market Cap	P/E Ratio	ROE	Dividend Yield	Revenue Growth	EPS Growth
DOCS	73 Outperform	$6.64B	26.58	24.61%	―	20.21%	44.14%
AMWL	55 Neutral	$72.03M	-0.59	-38.35%	―	4.33%	50.50%
Sector *	51 Neutral	$7.86B	-0.30	-43.30%	2.27%	22.53%	-2.21%
CARL	47 Neutral	$306.08M	-11.29	―	―	102.57%	-5.76%
TDOC	47 Neutral	$871.39M	-3.70	-15.42%	―	-2.37%	77.85%
BEAT	43 Neutral	$47.88M	-1.94	-792.01%	―	―	4.31%