GeneDx (WGS) Q4 2025: Exome and Genome Revenue Jumps 54% as Sales Force Expansion Targets Untapped Markets
GeneDx capped 2025 with rapid exome and genome growth, margin expansion, and a bold sales force ramp aimed at mainstreaming rare disease diagnostics. The company’s layered strategy leverages its Infinity data asset and new FDA device designation, setting up a multi-year run at new clinician segments and international opportunities. With foundational markets still underpenetrated and expansion bets in early innings, execution in 2026 will test both scale and operational discipline.
Summary
- Sales Force Tripling Targets New Markets: GeneDx is nearly tripling commercial headcount to penetrate general pediatrics, NICU, and prenatal channels.
- Margin Expansion Driven by Scale: Gross margin rose as higher value exome and genome tests displaced legacy panels, with further cost leverage expected.
- Infinity Data Asset Reinforces Leadership: Unique scale and diversity in rare disease data underpin competitive moat as new entrants emerge.
Performance Analysis
GeneDx delivered a strong Q4 finish, with total revenue of $121 million and full-year revenue reaching $428 million, underpinned by 54% exome and genome revenue growth. Exome and genome revenues comprised a significant portion of the total, reflecting the company’s strategic shift away from single-gene and multi-gene panels toward broader, higher-value testing. The company reported 27,761 exome and genome test results in Q4, marking a steady acceleration in volume growth throughout the year.
Gross margin reached 71% for Q4 and the full year, up from 65% in 2024 and 45% in 2023, driven by scale and improved reimbursement. Average reimbursement rates (ARR) for exome and genome tests increased to $3,750, compared to $2,500 in 2023 and $3,000 in 2024. While genome tests carry higher reagent costs, management expects these to decline as adoption accelerates. Adjusted net income was positive for both the quarter and the year, demonstrating operating leverage even as investments ramped.
- Volume Acceleration: Exome and genome test volume growth accelerated each quarter, ending the year at 34% YoY for Q4.
- Product Mix Shift: Geneticists increasingly shifted toward whole genome testing, supporting higher revenue per test and diagnostic yield.
- Cost Curve Downtrend: Scale efficiencies and product mix drove a multi-year gross margin expansion, with further room as genome COGS decline.
Legacy panels still represent over half of tests run, indicating substantial conversion runway. The company exited hereditary cancer testing in Q3, further focusing resources on rare disease genomics. Seasonal and weather-related volume swings were noted, but underlying demand and reimbursement trends remain positive into 2026.
Executive Commentary
"2026 is going to be a breakout year for GeneDx. We're operating in an enormous and largely untapped market with a 25-year head start. We've cemented our position as the clear leader in rare by diagnosing more patients with exome and genome than anyone else in the world, and we have the number one genetic test, the largest and most diverse rare disease data set, and the leading technology and team."
Catherine Stuland, President & Chief Executive Officer
"Full year 2023 gross margin was 45%, which went up to 65% in 2024, and now 71% in 2025. Genome costs more than exome today, but that's mostly a function of higher reagent costs, which we expect to continue to come down as the adoption curve ramps. Importantly, our dry side cost advantage applies equally between exome and genome."
Kevin Feely, Chief Financial Officer
Strategic Positioning
1. Infinity Data Asset as a Competitive Moat
Infinity, GeneDx’s proprietary rare disease data set, now includes over 2.5 million genetic tests and 8 million phenotypic data points. This scale, with deep parental and diverse ancestry representation, is critical for diagnosing novel variants—a unique challenge in rare disease. The compounding effect of new data increases diagnostic power and reinforces a durable first-mover advantage. AI models and clinical tools built on Infinity further accelerate diagnostic speed and accuracy, making replication by competitors extremely difficult.
2. Layered Market Expansion Strategy
GeneDx is executing a multi-pronged commercial expansion, nearly tripling its sales force to target underpenetrated and new clinician segments. Foundational markets (geneticists, pediatric neurology) remain the core, but expansion into NICU, general pediatrics, prenatal, adult neurology, and international software/interpretation is underway. General pediatrics is positioned as a “game changer,” with a new one-minute ordering experience and a dedicated 50-person team launching in mid-2026.
3. Conversion of Legacy Panels to Exome/Genome
Despite high share among geneticists, only 30% of their patients are tested with exome or genome, and over half of GeneDx’s own tests are still panels. Management sees a “tidal wave” of conversion as guidelines, education, and reimbursement catch up. This shift is expected to drive both volume and margin tailwinds for years as exome/genome tests replace lower-yield panels.
4. Deliberate Investment Cycle to Capture Market Share
GeneDx is prioritizing market capture over near-term margin, front-loading hiring and R&D in 2026. The company is launching a new customer portal for pediatricians, ramping R&D to support clinical research, and investing in long-read sequencing and other technologies to further boost diagnostic yield. Operating margin is expected to reach double digits by Q4 as new sales territories mature.
5. Regulatory and Policy Momentum
Recent FDA breakthrough device designation for its comprehensive genomic solution positions GeneDx for future regulatory and payer tailwinds. Management is also actively influencing state and federal policy for expanded Medicaid and biomarker coverage, though no upside from pending legislation is included in current guidance.
Key Considerations
GeneDx’s 2025 results reflect a business at the inflection of scale, but execution risk rises as the company pursues simultaneous expansion across new channels, products, and geographies.
Key Considerations:
- Sales Force Productivity Ramp: Nearly 100 new reps added in 2026, with productivity lag expected before full contribution, especially in general pediatrics and prenatal.
- Conservative Guide Leaves Room for Upside: Management’s volume and reimbursement assumptions for new markets are deliberately cautious, with no Medicaid expansion or legislative upside baked in.
- NICU and General Pediatrics as Near-Term Catalysts: Early signs of improved NICU utilization and positive feedback on pediatrician workflow could accelerate growth beyond baseline expectations.
- Data Asset and AI Leverage: Infinity’s breadth and annotation, combined with proprietary AI tools, provide a compounding advantage as scale grows.
- Gross Margin Sustainability: Mix shift toward genome and further cost curve compression are critical for maintaining and expanding high gross margins.
Risks
Execution risk is elevated as GeneDx pursues simultaneous expansion in multiple new markets and rapidly scales its commercial team. Reimbursement rates in new outpatient channels could lag expectations, especially as payers initially deny unfamiliar codes, requiring sustained appeals and evidence generation. Competitive entry is intensifying, though management sees the Infinity data asset and sales force scale as strong moats. Regulatory or policy delays, and slower-than-expected clinician adoption, could also dampen near-term results.
Forward Outlook
For Q1 2026, GeneDx guided to:
- 33% exome and genome volume growth baseline (implying a sequential volume step-down due to seasonality and weather)
For full-year 2026, management reaffirmed guidance:
- Total revenue of $540 to $555 million
- Exome and genome volume growth of 33% to 35%
- Adjusted gross margin ~70%
- Adjusted net income positive for the full year and each quarter, with Q1 near break-even
Management highlighted:
- Foundational markets expected to contribute 25% to 27% of growth, with expansion markets (NICU, general pediatrics, prenatal, adult, international) adding 7% to 8%
- Q4 2026 and 2027 expected to see inflection from general pediatrics and international ramp
Takeaways
GeneDx is executing a high-conviction, multi-layered growth plan built on its unique data asset, commercial scale, and regulatory progress.
- Exome and Genome Penetration Remains Early: With only 30% of eligible patients in core markets tested, conversion from panels remains a multi-year tailwind.
- Sales Force Expansion Will Test Operating Discipline: Execution on onboarding and productivity of 100 new reps is critical for hitting ambitious 2026 targets.
- Watch for Early Signals in NICU and General Pediatrics: Uptake in these channels, and success of the new ordering workflow, will be leading indicators for future volume acceleration.
Conclusion
GeneDx enters 2026 with momentum in both revenue and margin, but the true test will be translating a larger commercial footprint and data advantage into sustainable, broad-based growth. Investors should monitor execution in new markets and margin durability as scale increases.
Industry Read-Through
This quarter’s results underscore the compounding value of proprietary data assets and scale in the genomic diagnostics space. The rapid shift from panels to exome/genome tests reflects a broader industry trend toward comprehensive, high-yield diagnostics. Sales force expansion and clinician workflow optimization are increasingly critical as genomics moves into mainstream medicine. Competitors with smaller data sets or limited commercial reach will face rising barriers to entry, while payer and policy momentum is likely to accelerate adoption across the sector. Expect continued margin pressure for companies lacking scale, and further consolidation as reference data and AI become central to clinical differentiation.