Inspire Medical Systems, Inc. (INSP) 2026 Q1 法說會逐字稿

Good afternoon. My name is Dilem, and I'll be your conference operator today. At this time, I'd like to welcome everyone to the Inspire Medical Systems first quarter 2026 conference call. (Operator Instructions). After the speaker's remarks, there will be a question-and-answer session.

下午好。我叫 Dilem，今天將擔任本次電話會議的接線員。此刻，我謹代表主辦方歡迎各位參加 Inspire Medical Systems 2026 會計年度第一季電話會議。(接線員指示)。在講者致詞結束後，將進行問答環節。

I'll now hand the conference over to your first speaker, Ezgi Yagci, the Vice President of Investor Relations at Inspire. You may begin the conference.

接下來我將把會議交給第一位講者：Inspire 投資人關係副總裁 Ezgi Yagci。您可以開始會議。

Thank you, Dilem, and thank you all for participating in today's call. Joining me are Tim Herbert, Chairman and Chief Executive Officer; and Matt Osberg, Chief Financial Officer. Earlier today, we released financial results for the three months ended March 31, 2026. A copy of the press release is available on our website.

謝謝你，Dilem，也感謝各位參與今天的電話會議。與我一同出席的還有董事長兼執行長 Tim Herbert，以及財務長 Matt Osberg。今天稍早，我們已公布截至 2026 年 3 月 31 日止三個月的財務結果。新聞稿副本可於我們的網站取得。

On this call, management will make forward-looking statements within the meaning of the federal securities laws. All forward-looking statements, including, without limitation, those relating to our operations, financial results and financial condition, investments in our business, full year 2026 financial and operational outlook and changes in market access and different aspects of coding or reimbursement are based upon our current estimates and various assumptions.

在本次電話會議中，管理團隊將依據聯邦證券法之定義發表前瞻性陳述。所有前瞻性陳述（包括但不限於與我們的營運、財務結果與財務狀況、對業務的投資、2026 全年財務與營運展望，以及市場准入與編碼或給付/報銷等不同面向之變動相關者）均係基於我們目前的估計與各項假設。

Forward-looking statements involve material risks and uncertainties that could cause actual results or events to materially differ. Accordingly, you should not place undue reliance on these statements. For a discussion of these risks and uncertainties, please see our filings with the Securities and Exchange Commission, including our periodic reports on Form 10-K and 10-Q as well as the Form 10-Q, which we filed this afternoon with the SEC for the quarter ended March 31, 2026.

前瞻性陳述涉及重大風險與不確定性，可能導致實際結果或事件出現重大差異。因此，您不應過度依賴這些陳述。關於上述風險與不確定性的討論，請參閱我們向美國證券交易委員會（SEC）提交的文件，包括定期的 Form 10-K 與 10-Q 報告，以及我們於今日下午就截至 2026 年 3 月 31 日止季度向 SEC 提交的 Form 10-Q。

Inspire disclaims any intention or obligation, except as required by law, to update or revise any financial projections or forward-looking statements, whether because of new information, future events or otherwise. This conference call contains time-sensitive information and speaks only as of the live broadcast today, May 4, 2026.

除法律要求外，Inspire 不承擔任何更新或修訂任何財務預測或前瞻性陳述之意圖或義務，不論係因新資訊、未來事件或其他原因。本次電話會議包含具時效性的資訊，僅以今日（2026 年 5 月 4 日）直播當時為準。

With that, it is my pleasure to turn the call over to Tim Herbert. Tim?

接下來，我很高興把電話會議交給 Tim Herbert。Tim？

Thank you, Ezgi, and thanks, everyone, for joining us today. On the call today, I will start by providing some key takeaways of our first quarter results, including an update on coding and reimbursement. I will also provide some insight into our revised outlook for the year, and we'll then turn it over to Matt, who will provide additional insights on our first quarter and full year financials. We will then open up the call for questions.

謝謝你，Ezgi，也感謝各位今天加入我們。今天的電話會議中，我將先分享第一季業績的一些重點摘要，包括編碼與給付/報銷的最新進展。我也會就我們修訂後的全年展望提供一些看法，接著交由 Matt 補充第一季與全年財務的更多細節。之後我們將開放提問。

First, I want to highlight how pleased we are with the team's execution in the first quarter. Despite challenges related to coding and reimbursement uncertainty as well as the WISeR program, the organization delivered revenue growth and improved adjusted operating income and operating cash flow compared to the prior year period. In this environment, it is critical that we focus on the factors within our control.

首先，我想強調我們對團隊在第一季的執行表現感到非常滿意。儘管面臨與編碼及給付/報銷不確定性以及 WISeR 計畫相關的挑戰，組織仍實現營收成長，且相較去年同期，調整後營業利益與營運現金流均有所改善。在此環境下，聚焦於我們可控的因素至關重要。

Our first quarter results demonstrate this as well as our focus on prioritizing revenue-generating activities and maintaining disciplined cost management while continuing to make targeted investments to support long-term growth. We believe these actions position the company well, both in the near and long term.

我們第一季的結果展現了這一點，也反映出我們專注於優先推動創造營收的活動、維持嚴謹的成本管理，同時持續進行有針對性的投資以支持長期成長。我們相信，這些作為使公司在短期與長期都處於有利位置。

As we progress through the first quarter, we saw many developments with respect to coding and reimbursement, and we are diligently working to establish a consistent methodology to coding of the Inspire V procedure in the short term. The long-term solution is to establish a new CPT code for a single lead Inspire system. This is a long process. And if approved, we expect this new CPT code to become effective on January 1, 2028. Therefore, we are establishing short-term remedies for the various payers to bridge until the new CPT code is in place.

隨著第一季的推進，我們在編碼與給付/報銷方面看到許多進展，我們也正積極努力在短期內建立 Inspire V 手術編碼的一致方法。長期解方是為單導線（single lead）的 Inspire 系統建立新的 CPT 代碼。這是一個漫長的流程。若獲核准，我們預期該新 CPT 代碼將於 2028 年 1 月 1 日生效。因此，在新 CPT 代碼到位之前，我們正針對不同付款方建立短期補救措施以作為銜接。

For centers concerned with the Inspire V reimbursement, we have inventory of Inspire IV, which has proven itself to be an extremely effective therapy with clear coding and reimbursement. As for coding for Inspire V systems, we are working with physicians, centers and payers to establish clear and consistent coding and reimbursement guidelines, and there was progress in the first quarter.

對於擔心 Inspire V 給付/報銷的醫療中心，我們備有 Inspire IV 的庫存；Inspire IV 已證明是一項極為有效的治療，且其編碼與給付/報銷明確。至於 Inspire V 系統的編碼，我們正與醫師、醫療中心及付款方合作，以建立清楚且一致的編碼與給付/報銷指引，而第一季已有所進展。

For Medicare patients, the Centers for Medicare and Medicaid Services, or CMS, announced the creation of a C-code to be used with Inspire V procedures. And the Medicare Administrative Contractors, or MACs, are beginning to incorporate the C-code into their local policies. This provides a reliable solution for hospitals and ambulatory surgical centers. And importantly, the facility payment is equal to the Inspire IV CPT code 64582.

針對 Medicare 病患，醫療保險與醫療補助服務中心（CMS）宣布建立一個可用於 Inspire V 手術的 C-code。而 Medicare 行政承包商（MAC）也開始將該 C-code 納入其地方政策。這為醫院與門診手術中心提供了可靠的解決方案。更重要的是，機構端（facility）的給付金額與 Inspire IV 的 CPT 代碼 64582 相同。

Staying with Medicare for physicians. Currently, the MAC lists the Inspire IV CPT code 64582 without the use of a modifier. As such, the majority of Medicare cases this year have been billed without the use of a modifier, and we will continue to monitor this throughout the year. At this point, the commercial payers continue to list CPT code 64568 for Inspire V procedures.

同樣就 Medicare 的醫師端而言。目前，MAC 列示 Inspire IV 的 CPT 代碼 64582，且不需使用修飾碼（modifier）。因此，今年大多數 Medicare 案例在申報時未使用修飾碼；我們將在全年持續監測此情況。就目前而言，商業保險付款方仍將 Inspire V 手術列示為 CPT 代碼 64568。

There is guidance provided by societies, including a nonbinding newsletter from the American Hospital Association recommending the use of an unlisted CPT code, specifically 64999. However, the use of an unlisted code requires manual reviews and additional support from centers. Because of this, many centers and payers may be reluctant to adopt the use of this unlisted code.

各學會亦提供相關指引，包括美國醫院協會（AHA）發布的一份不具拘束力的電子報，建議使用未列名（unlisted）的 CPT 代碼，具體為 64999。然而，使用未列名代碼需要人工審查，且醫療中心需提供額外支援資料。因此，許多醫療中心與付款方可能不願採用此未列名代碼。

The good news for commercial payers is each case is prior authorized, meaning the billing code is approved in the prior authorization before the procedure, significantly reducing payment uncertainty for the center. Medicare Advantage is managed by commercial payers, and we recommend consistent coding practices as defined by the payer, and Medicare Advantage patients are also prior authorized.

對商業保險付款方而言，好消息是每個案例都會先取得事前授權（prior authorization），也就是在手術前，申報代碼已於事前授權中獲核准，從而大幅降低醫療中心的給付不確定性。Medicare Advantage 由商業保險付款方管理；我們建議依付款方所定義的方式採取一致的編碼作法，而 Medicare Advantage 病患同樣需要事前授權。

Although challenging, there has been progress in coding and reimbursement, and we've seen initial billing practices being established by physicians and centers in response to the changes in coding. However, we recognize that significant uncertainty remains, and we will continue to support our customers as they navigate the path forward. This coding uncertainty has adversely impacted the number of patients in the pipeline, including the number of prior authorizations submitted to commercial payers as we moved through the first quarter.

儘管具挑戰性，編碼與給付/報銷方面已有所進展；我們也看到醫師與醫療中心因應編碼變更，開始建立初步的申報作法。然而，我們也認知仍存在顯著不確定性，並將持續支持客戶在未來道路上前行。這種編碼不確定性已對管線中的病患數量造成不利影響，包括在第一季期間提交給商業保險付款方的事前授權件數。

We expect this trend to reverse and improve in the remainder of the year as we continue to support prior authorizations and build confidence in the coding processes and guidelines. To further support patient access to therapy, we are increasing our assistance to customers by providing additional proactive education relating to prior authorization and billing processes, and we are adding to our field reimbursement team.

我們預期，隨著我們持續支援事前授權、並在編碼流程與指引上建立信心，這一趨勢將在今年剩餘期間反轉並改善。為進一步支持病患取得治療，我們正加大對客戶的協助，提供更多與事前授權及申報流程相關的主動式教育，並擴編我們的外勤給付/報銷團隊。

Our goal is to provide as much clarity to our customers as possible to mitigate disruptions to patient access to care. Switching to the WISeR program. WISeR is a government initiative requiring AI-reviewed prior authorization for Medicare cases in six pilot states, and the program kicked off in mid-January of 2026. During the first quarter, the WISeR program created prior authorization delays for traditional Medicare procedures in the 6 WISeR states, resulting in a headwind to our first quarter revenue. As we continue to gain experience working with the new systems in these states, we anticipate the headwinds to abate in the remainder of the year.

我們的目標是盡可能為客戶提供最大程度的清晰度，以減輕病患取得照護的中斷。接著談 WISeR 計畫。WISeR 是一項政府倡議，要求在六個試點州對 Medicare 案件進行由 AI 審核的事前授權；該計畫於 2026 年 1 月中旬啟動。第一季期間，WISeR 計畫使六個 WISeR 州的傳統 Medicare 手術出現事前授權延遲，因而對我們第一季營收造成逆風。隨著我們在這些州持續累積與新系統合作的經驗，我們預期今年剩餘期間逆風將逐步減弱。

With the ongoing coding and reimbursement challenges and the WISeR program impact, we are revising our full year revenue outlook. In light of our lower revenue outlook and as we demonstrated in the first quarter, we will continue to be disciplined with our spending and focus on prioritizing revenue-generating activities while still making progress long-term growth investments.

鑑於持續的編碼與給付（reimbursement）挑戰以及 WISeR 計畫的影響，我們正在修訂全年營收展望。考量到我們較低的營收展望，並如同我們在第一季所展現的，我們將持續嚴守支出紀律，聚焦優先推動創收活動，同時仍推進長期成長投資。

In addition to enhancing our support to customers for proactive education and assistance with prior authorization and billing processes, we are also prioritizing projects to drive an improved patient care pathway, enhanced marketing effectiveness, improved digital product experience, continued R&D for new product development and operational efficiencies.

除了加強對客戶的支援，提供事前授權（prior authorization）與帳務（billing）流程的主動教育與協助外，我們也將優先推動多項專案，以促進更完善的病患照護流程、提升行銷成效、改善數位產品體驗、持續投入新產品研發（R&D）以及提升營運效率。

We believe that these projects in these areas can begin to deliver returns in the second half of 2026 and accelerate in 2027. We continue to remain focused on our commitment to put the patient first and deliver strong patient outcomes. We continue to believe that there is a large untreated population of people struggling with sleep apnea that can benefit from Inspire therapy, and we continue to be encouraged by the strong adoption of Inspire V and the positive data we continue to collect.

我們相信，這些領域的專案可望在 2026 年下半年開始帶來回報，並於 2027 年加速。我們仍將專注於「以病患為先」的承諾，並交付強勁的病患治療成效。我們仍相信，有大量未接受治療、正受睡眠呼吸中止症困擾的人口可受益於 Inspire 治療；同時，我們也持續受到 Inspire V 強勁採用情況以及我們持續蒐集到的正面數據所鼓舞。

At the upcoming Sleep Conference in Baltimore in June, we will be presenting the full results from the Inspire V trial conducted in Singapore. While we have previewed some of the early data points, including inspiratory overlap, this is the first time we will be showing the full trial results, including the ability of the new accelerometer-based sensing technology and the safety and efficacy of the Inspire V implant.

在 6 月於巴爾的摩舉行的睡眠會議上，我們將發表在新加坡進行的 Inspire V 試驗完整結果。雖然我們先前已預覽部分早期數據點（包括吸氣重疊 inspiratory overlap），但這將是我們首次展示完整試驗結果，其中包含新型加速度計（accelerometer）感測技術的能力，以及 Inspire V 植入物的安全性與有效性。

Additionally, the Inspire ADHERE trial is now complete. The data from the 5,000-patient cohort will be presented at the Sleep Conference. This is a real-world cohort demonstrating the effectiveness of Inspire as it is delivered today and builds upon our previous safety and efficacy trials. We will further highlight the effects of Inspire therapy on cardiovascular outcomes, utilizing a large claims database to retrospectively examine incident cases of cardiovascular disease after Inspire implantation as compared to a matched group of patients receiving CPAP therapy and those not receiving treatment.

此外，Inspire ADHERE 試驗現已完成。這個 5,000 名病患隊列（cohort）的數據將在睡眠會議上發表。這是一個真實世界（real-world）隊列，展示 Inspire 在目前臨床實務交付方式下的有效性，並在我們先前的安全性與有效性試驗基礎上進一步延伸。我們也將利用大型理賠（claims）資料庫，回溯性檢視 Inspire 植入後心血管疾病新發（incident）病例，並與接受 CPAP 治療以及未接受治療的配對病患群組進行比較，以進一步凸顯 Inspire 治療對心血管結局的影響。

At the Sleep Conference, we will present this study on the cardiovascular outcomes, along with 2 other independent studies using two different claims databases to compare the use of various claims databases in the demonstration of improved cardiovascular and respiratory outcomes associated with Inspire therapy.

在睡眠會議上，我們將發表這項心血管結局研究，並同時發表另外兩項獨立研究；這兩項研究使用兩個不同的理賠資料庫，比較各類理賠資料庫在證明 Inspire 治療可改善心血管與呼吸結局方面的應用。

In addition, a third independent study from Virginia Commonwealth University was just published in the peer-reviewed journal. The data demonstrated that the Inspire patient cohort had significantly lower odds of stroke, myocardial infarction, atrial fibrillation, acute heart failure, acute respiratory failure and hospitalization to name a few, with at least 2 years follow-up. These strong results suggest Inspire provides systemic cardiovascular and respiratory health benefits and reduces health care burden compared to CPAP. We expect further studies to support these findings.

此外，來自維吉尼亞聯邦大學（Virginia Commonwealth University）的第三項獨立研究，剛剛已刊登於同儕審查期刊。數據顯示，在至少 2 年追蹤下，Inspire 病患隊列在中風、心肌梗塞、心房顫動、急性心衰竭、急性呼吸衰竭以及住院等多項事件上的勝算（odds）顯著較低（僅舉數例）。這些強勁結果顯示，相較於 CPAP，Inspire 可帶來全身性的心血管與呼吸健康效益，並降低醫療負擔。我們預期後續研究將支持這些發現。

We are happy to report that the PREDICTOR manuscript has been accepted by a major medical journal, and we look forward to the publication in the coming weeks. As you are aware, PREDICTOR is the 600-patient study we conducted to demonstrate alternative screening options to replace the drug-induced sleep endoscopy or DISE procedure for a large subset of eligible patients, improving the patient experience and reducing the time line to implant. Last but not least, last month, we published our 2025 patient experience report. Highlighted in the report is a continued improvement in our revision and EXPAND rates, which were 1.7% and less than 1%, respectively for full year 2024.

我們很高興報告，PREDICTOR 論文已獲一家主要醫學期刊接受，並期待在未來幾週內刊登。如各位所知，PREDICTOR 是我們進行的一項 600 名病患研究，旨在證明可用替代篩檢選項，取代對大量符合資格病患子群所需的藥物誘導睡眠內視鏡（drug-induced sleep endoscopy，DISE）程序，以改善病患體驗並縮短至植入的時間線。最後但同樣重要的是，上個月我們發布了 2025 年病患體驗報告。報告重點指出，我們的修正（revision）率與 EXPAND 率持續改善，2024 全年分別為 1.7% 與低於 1%。

In summary, we remain focused on providing the best therapy solution for patients and helping our customers navigate what we believe will be a temporary market disruption related to coding and reimbursement and the WISeR program. We are actively addressing the challenges posed by this disruption, and we remain excited about our product and the market opportunity to improve the lives of our patients as we've already done for over 135,000 patients since our inception. We will continue to take actions to position the company for long-term profitable growth, and we believe that we have the right strategies in place to drive long-term stakeholder value.

總結而言，我們仍專注於為病患提供最佳治療解決方案，並協助客戶因應我們認為屬於暫時性的市場干擾（與編碼、給付以及 WISeR 計畫相關）。我們正積極處理此干擾所帶來的挑戰，同時我們仍對產品以及改善病患生活的市場機會感到振奮——自公司成立以來，我們已為超過 135,000 名病患帶來改善。我們將持續採取行動，使公司具備長期獲利成長的定位；我們相信已具備正確策略，以驅動長期利害關係人價值。

I'll now turn the call over to Matt for his review of our financial performance.

接下來我把電話會議交給 Matt，由他回顧我們的財務表現。

Thank you, Tim, and good afternoon, everyone. First, I'll begin with a review of the first quarter results and then follow with commentary on our outlook for the remainder of 2026. Revenue increased 1.6% to $204.6 million, primarily driven by increased market penetration. As Tim mentioned, in the first quarter, we experienced disruption related to coding and reimbursement challenges and the WISeR program, and we estimate that these items adversely impacted revenue by approximately $20 million.

謝謝你，Tim，各位下午好。首先，我將回顧第一季業績，接著說明我們對 2026 年剩餘期間的展望。營收成長 1.6% 至 2.046 億美元，主要由市場滲透率提升所帶動。如 Tim 所提到，第一季我們受到與編碼與給付挑戰以及 WISeR 計畫相關的干擾，我們估計這些因素對營收造成約 2,000 萬美元的不利影響。

Operating margin and adjusted operating margin improved primarily driven by gross profit expansion due to a higher sales mix of Inspire V systems. The effective tax rate increased to 571.2%, primarily driven by tax shortfalls related to our stock-based compensation which were created by a decline in our stock price at award vesting date compared to the stock price at grant date.

營業利益率與調整後營業利益率改善，主要由毛利擴張所帶動，原因是 Inspire V 系統的銷售組合占比提高。有效稅率上升至 571.2%，主要是因股權基礎給付（stock-based compensation）相關的稅務短缺（tax shortfalls）所致；該短缺源於獎酬歸屬（vesting）日的股價相較於授予（grant）日股價下跌。

Additionally, in the prior year period, we maintained a full valuation allowance against federal and state deferred tax assets. The adjusted effective tax rate, which removes the impact of stock-based compensation, was 25.7%. As we mentioned on our fourth quarter call, as we are in a situation where our pretax income is relatively small base, certain discrete tax charges can have a material impact on our tax rate.

此外，在前一年同期，我們對聯邦與州的遞延所得稅資產維持全額估值備抵（valuation allowance）。調整後有效稅率（排除股權基礎給付影響）為 25.7%。如我們在第四季電話會議所提到，當我們的稅前所得基數相對較小時，某些一次性（discrete）稅務費用可能會對稅率造成重大影響。

Due to the fact that we have a significant amount of stock-based compensation outstanding and due to the volatility of our stock price, the tax impact of stock-based compensation on our effective tax rate can be material and could have significant variability from year-to-year. We expect the tax impact from stock-based compensation will be concentrated in the first quarter of the year as that is when the majority of our vesting of our RSUs and PSUs occur.

由於我們有相當規模的股權基礎給付尚未歸屬，且股價波動較大，股權基礎給付對有效稅率的稅務影響可能相當顯著，並可能在年度之間出現大幅變動。我們預期股權基礎給付的稅務影響將集中在第一季，因為多數 RSU 與 PSU 的歸屬發生在第一季。

Diluted EPS was a loss of $0.39 and adjusted diluted EPS was $0.10 for the quarter. Our adjusted EBITDA margin, which excludes the impact of stock-based compensation, improved 100 basis points to 17.5%. Turning to cash flow and the balance sheet. Operating cash flow was $12.8 million for the quarter, an improvement of $20 million compared to the first quarter of the prior year, primarily driven by improved working capital, partially offset by a higher net loss in the current period.

稀釋後每股盈餘（EPS）為虧損 0.39 美元，本季調整後稀釋 EPS 為 0.10 美元。我們的調整後 EBITDA 利益率（排除股權基礎給付影響）提升 100 個基點至 17.5%。接著談現金流與資產負債表。本季營運現金流為 1,280 萬美元，較前一年第一季改善 2,000 萬美元，主要由營運資金改善所帶動，但部分被本期較高的淨損所抵銷。

Our balance sheet remains strong with no debt and $400 million in cash and investments at the end of the quarter. Our strong cash position allows us to remain focused on making investments to drive profitable growth. We ended the quarter with 284 US territories and 288 US field clinical representatives. We are being strategic in our approach to territory management and optimizing our model through targeted territory consolidation. We hired 13 field clinical reps in the quarter and are now at our goal of one territory manager to one field clinical rep.

我們的資產負債表依然穩健，期末無負債，現金與投資合計 4 億美元。充裕的現金部位使我們能持續專注於投資，以推動獲利成長。本季末我們在美國共有 284 個銷售區域（territories）以及 288 名美國外勤臨床代表（field clinical representatives）。我們在區域管理上採取策略性作法，透過有針對性的區域整併來優化我們的模式。本季我們新聘 13 名外勤臨床代表，目前已達成每位區域經理對應一位外勤臨床代表的目標配置。

Turning now to our 2026 outlook. We are revising our full year revenue outlook to be in the range of $825 million to $875 million. This range incorporates updated assumptions of the expected impact on our full year results from continued coding and reimbursement uncertainty and the WISeR program. As I mentioned, our first quarter revenue was adversely impacted by coding and reimbursement challenges and the WISeR program by an estimated $20 million.

接著談我們對 2026 年的展望。我們將全年營收展望修訂為 8.25 億至 8.75 億美元。此區間納入更新後的假設，反映持續的編碼與給付不確定性以及 WISeR 計畫對全年業績的預期影響。如我所提到，我們第一季營收因編碼與給付挑戰以及 WISeR 計畫而受到估計約 2,000 萬美元的不利影響。

We expect the adverse impact of these items to increase to approximately $40 million to $50 million in the second quarter as we see a more dramatic impact on our second quarter revenue due to the decline in pre-authorizations in the first quarter as changes in preauthorization rates typically impact revenue on a one quarter lag.

我們預期，隨著第一季預先授權（pre-authorization）下滑對第二季營收造成更明顯的影響（因為預先授權比率的變動通常會以一季的落後期反映在營收上），這些項目的不利影響在第二季將增加至約4,000萬至5,000萬美元。

We expect the adverse revenue impact from these items to improve sequentially from the second quarter as we progress into the third and fourth quarters as our customers receive more education and build experience with coding and billing processes and as we continue to gain experience working with the WISeR state systems.

我們預期，隨著客戶獲得更多教育並累積編碼與帳務（coding and billing）流程的經驗，以及我們持續累積與WISeR州系統合作的經驗，這些項目對營收的不利影響將自第二季起逐季改善，並延續至第三季與第四季。

For the full year, we are currently estimating the total impact of these items to be in a range of $120 million to $150 million. Due to the nature of the items noted, the estimated impact of these factors on our first quarter results and full year outlook reflect high-level assumptions based on currently available data and incorporate inherent uncertainty related to quantifying how each of these items impacts customers, physicians and patients. The ultimate impact of these items may differ materially from current expectations based on how quickly coding and reimbursement clarity evolves over the fiscal year.

就全年而言，我們目前估計這些項目的總影響約在1.2億至1.5億美元之間。由於上述項目的性質，這些因素對我們第一季結果與全年展望的估計影響，係基於目前可得資料所作的高層次假設，並包含在量化各項目如何影響客戶、醫師與病患時所固有的不確定性。隨著本會計年度內編碼與給付（reimbursement）明確性演進的速度不同，這些項目的最終影響可能與目前預期存在重大差異。

Although we believe there is a long-term benefit to our market from GLP-1s as prospective patients lose weight and become eligible for Inspire therapy, we also believe that in the short term, our revenue is being adversely impacted by their increasing prevalence and adoption. Our ability to estimate the potential impact of GLP-1 therapies on revenue is subject to meaningful uncertainty and relies on limited and evolving data regarding patient behavior, physician prescribing patterns, referral dynamics and payer coverage decisions and may not fully capture developments in longer-term treatment options for obstructive sleep apnea.

雖然我們相信，從長期來看，GLP-1藥物可使潛在病患減重並因此符合Inspire治療資格，對我們市場具有正面效益；但我們也認為，短期內其日益普及與採用正在對我們營收造成不利影響。我們對GLP-1療法對營收之潛在影響的估計存在顯著不確定性，且仰賴有限且仍在演變的資料（包括病患行為、醫師處方模式、轉介動態與支付方給付決策），並可能無法完全涵蓋阻塞型睡眠呼吸中止症（obstructive sleep apnea）較長期治療選項的發展。

In addition to revising our revenue outlook, we are also revising our outlook on profitability metrics for the year. We now expect adjusted operating margin in the range of 2% to 4%, diluted EPS in the range of $0.07 to $0.62 and adjusted diluted EPS in the range of $0.75 to $1.25. The changes to these metrics primarily represent the impact of the lower revenue outlook, partially offset by continued actions to reduce operating expenses. Our updated outlook assumes an effective tax rate of 65% to 70% and an adjusted effective tax rate of 27% to 29%. The increase in the effective rates -- tax rates as compared to our previous outlook primarily relates to lower expected pretax income.

除修正我們的營收展望外，我們也正在修正今年的獲利能力指標展望。我們目前預期調整後營業利益率介於2%至4%，稀釋後每股盈餘（diluted EPS）介於0.07至0.62美元，調整後稀釋EPS介於0.75至1.25美元。這些指標的變動主要反映較低的營收展望之影響，並由持續降低營業費用的措施部分抵銷。我們更新後的展望假設有效稅率（effective tax rate）為65%至70%，調整後有效稅率為27%至29%。有效稅率上升——相較於我們先前展望的稅率——主要與預期稅前所得較低有關。

Our outlook assumes estimated weighted average diluted shares outstanding of approximately 29.4 million and capital expenditures between $40 million and $45 million. Looking at the cadence of the year, we are forecasting a 9% to 11% year-over-year revenue decline in the second quarter of 2026 due to the expected ongoing impact of coding and reimbursement uncertainty, the impact of the WISeR program and lower expected commercial procedures driven by a reduction in pre-authorizations in the first quarter.

我們的展望假設估計加權平均稀釋流通股數約為2,940萬股，資本支出介於4,000萬至4,500萬美元。就年度節奏而言，我們預測2026年第二季營收將年減9%至11%，原因在於預期編碼與給付不確定性持續影響、WISeR計畫的影響，以及第一季預先授權減少所導致的商業保險手術量低於預期。

Additionally, we expect an adjusted operating loss in the second quarter of $10 million to $15 million, primarily due to our lower revenue expectation and sequentially higher operating expenses as compared to the first quarter, primarily due to higher stock-based compensation expense.

此外，我們預期第二季調整後營業損失為1,000萬至1,500萬美元，主要由於我們較低的營收預期，以及相較第一季營業費用逐季上升（主要因股票基礎薪酬費用較高）。

We expect sequential improvement from Q2 in both our revenue and adjusted operating income in the back half of the year with the fourth quarter having the highest levels of the year. As we demonstrated in the first quarter, we will continue to be disciplined with our spending and focus on prioritizing revenue-generating activities while still making investments in long-term growth.

我們預期在下半年，營收與調整後營業利益將自第二季起逐季改善，其中第四季將達到全年最高水準。如同我們在第一季所展現的，我們將持續嚴守支出紀律，聚焦優先推動能帶來營收的活動，同時仍會投資於長期成長。

In closing, despite the dynamic reimbursement landscape, our team remains committed to providing strong patient outcomes and supporting our customers. As we look ahead to the remainder of 2026, we will continue to emphasize execution and remain focused on what we can control in order to drive long-term shareholder value. This concludes our prepared remarks.

最後，儘管給付環境多變，我們的團隊仍致力於提供良好的病患治療結果並支持我們的客戶。展望2026年剩餘期間，我們將持續強調執行力，並專注於我們可控的事項，以推動長期股東價值。以上為我們的預先準備發言。

Dilem, you may now open the line for questions.

Dilem，現在可以開放提問。

(Operator Instructions)

（接線員指示）

Robbie Marcus, JPM.

JPM的Robbie Marcus。

This is Lily on for Robbie. Maybe just starting with the guidance. I was hoping you could walk through your thinking behind the updated range. I think what we're all trying to figure out is how derisked the guide is now. So can you walk through the assumptions that you're making around reimbursement and the confusion around the reimbursement and what that looks like the rest of the year? And why are you confident that this is now the right range, and it's one that you can not just meet but hopefully exceed.

我是代替Robbie的Lily。我想先從財測指引開始。希望你們能說明一下更新後區間背後的思考。我想大家都在試圖釐清的是，目前這份指引的風險已降低到什麼程度。所以能否談談你們對給付的假設、以及給付混亂的情況在今年剩餘時間會是什麼樣子？以及你們為何有信心這就是正確的區間，而且不僅能達成、甚至希望能超越。

Thank you very much, Lily, and thanks for the question. I do want to just highlight a little bit on the reimbursement and center -- each center looks at it a little bit differently. So what our goal is to really focus the centers and providing education and a methodology that they're comfortable with to consistently start billing -- coding and billing for patients, both Medicare and commercial.

非常感謝你，Lily，也謝謝你的提問。我想先稍微強調一下給付以及各中心——每個中心對此的看法都略有不同。因此，我們的目標是讓各中心聚焦於提供教育，以及一套他們能夠接受的方法論，讓他們能一致地開始為病患進行請款——也就是編碼與帳務處理，涵蓋Medicare與商業保險。

And our assumptions is that will improve as we progress through the year. But we know, as Matt mentioned, there's a 1 quarter lag in prior authorization. So as the coding impact or uncertainty unfolded in the beginning of the year, a lot of centers put on the brake to make sure they understood it before they proceeded forward with prior authorization. So our core assumption -- and I'll let Matt jump in.

我們的假設是，這種情況會隨著年度推進而改善。但我們也知道，如Matt所提到，事前授權（prior authorization）存在一季的落後期。因此，當年初編碼影響或不確定性浮現時，許多中心踩了煞車，先確保理解後才繼續推進事前授權。所以我們的核心假設——我也讓Matt補充。

Our core assumption is that we are going to be able to build that confidence as we move through the quarter and improve prior authorizations here in the second quarter and beyond, and that will show a net benefit or a benefit in implants and revenue as we progress through the year.

我們的核心假設是，隨著本季推進，我們將能建立這份信心，並在第二季及之後改善事前授權，而這將在全年推進過程中，對植入量與營收帶來淨正面效益或正面效益。

Yes. Lily, it's Matt. Maybe following up on what Tim said. As I pointed out, we saw a $20 million impact in Q1. We're estimating that accelerates and gets to $40 million to $50 million in Q2. And then I think if you look at the range for the year, and back into what Q3 and Q4 might be, you can still see there's fairly significant impacts on the third and fourth quarter, although they're improving from the impact that we had in Q2. So we still have risk in for the remainder of the year, although that risk is abating a bit from the second quarter.

是的。Lily，我是Matt。延續Tim所說的。如我指出的，我們在第一季看到2,000萬美元的影響。我們估計第二季影響會加速擴大至4,000萬至5,000萬美元。若你看全年區間，並回推第三季與第四季可能的情況，你仍可看到第三、第四季仍有相當顯著的影響，儘管相較第二季的影響會有所改善。因此，今年剩餘期間我們仍納入風險考量，只是相較第二季，該風險正在逐步緩解。

Jon Block, Stifel.

Stifel的Jon Block。

I'll adhere to the one question, maybe one and a half. So just first, in terms of the $120 million to $150 million impact for the year from reimbursement headwinds. Tim, where do those revenues go? And maybe importantly, what can the company do to ensure they sort of stay hot leads at some point and don't leave whether that's coming back in 2027 or even beyond.

我會遵守只問一個問題，或一個半。首先，關於全年因給付逆風造成的1.2億至1.5億美元影響。Tim，那些營收去哪裡了？以及更重要的是，公司能做什麼來確保這些機會在某個時間點仍維持為高意向線索（hot leads），而不會流失——不論是2027年回來，甚至更久之後才回來。

Maybe you can talk to that a bit. And then just to push on the improvement into the back part of the year, if I'm framing that correctly. If there's this one quarter lag from preauthorization to getting through the funnel, call it, I mean, are you starting to see anything thaw, right? It's early May. You are anticipating some sort of improvement 2Q to 3Q. So maybe help us out, just like real time, are there any green shoots that's starting to take place?

也許你可以談談這點。另外再追問一下你提到下半年改善的部分，如果我理解正確的話。如果從事前授權到通過漏斗（funnel）有一季的落後期，那麼你們是否已開始看到一些解凍的跡象？現在是5月初。你們預期第二季到第三季會有某種改善。所以能否協助我們從即時角度理解：是否已有任何萌芽的正向訊號開始出現？

Absolutely. Very good. John, great point on the hot leads. Yes, we make sure we work with our centers to keep track of the patients. We do work with them on their prior authorization. and help them get those submissions in. But we also help patients make that first appointment.

當然。非常好。John，你對於高意向線索（hot leads）的觀點很到位。是的，我們會確保與我們的中心合作，追蹤病患。我們確實會與他們一起處理事前授權（prior authorization），並協助他們完成提交。但我們也會協助病患安排第一次門診預約。

We're trying to make sure we stay in contact with all these patients to give them the opportunity to receive Inspire therapy. We know they are there and still require treatment. So we're doing everything we can to make sure we continue to communicate with them and work with the centers to track them and work with their prior authorizations.

我們正努力確保與所有這些病患保持聯繫，讓他們有機會接受 Inspire 治療。我們知道他們仍在那裡，且仍需要治療。因此我們會盡一切所能，確保持續與他們溝通，並與中心合作追蹤他們、處理他們的事前授權。

As far as seeing some improvements, I think with Medicare and the changes that we have there with the new C-code not being incorporated into the MAC, LCDs, local coverage determinations, we're starting to see a little headway there, and that's important as well as surgeons having experience billing the Inspire IV code without modification. And the more experience we get there, I think that will build on itself. And even if there's a modifier down the road that we would minimize any kind of negative impact to that.

至於看到一些改善，我認為在 Medicare 方面，以及我們在那裡的變更——新的 C-code 尚未被納入 MAC、LCD（地方給付決定，local coverage determinations）——我們開始看到一些進展，這很重要；同時外科醫師也逐漸累積在不加修飾碼（modifier）的情況下，申報 Inspire IV 代碼的經驗。而我們在這方面累積的經驗越多，我認為就會形成正向循環。即使未來需要加上修飾碼，我們也會把任何負面影響降到最低。

And then secondly, when we start looking at the WISeR cases and we gain experience in those 6 states to be able to work through the prior authorization and be able to improve that process, and that will continue to improve as we get to second, third and fourth quarters.

其次，當我們開始檢視 WISeR 案例，並在那 6 個州累積經驗，以便能夠處理事前授權並改善流程時，隨著進入第二、第三與第四季，這個流程將會持續改善。

Adam Maeder, Piper Sandler.

Adam Maeder，Piper Sandler。

I guess I wanted to ask just one kind of bigger picture question on the revised outlook. And I just wanted to confirm, Tim or Matt, that the guidance cut is entirely related to the reimbursement coding uncertainty plus the headwind from WISeR. Is that the case?

我想我想問一個比較宏觀的問題，關於修訂後的展望。我只是想確認一下，Tim 或 Matt，這次下修指引完全是因為報銷編碼（reimbursement coding）的不確定性，再加上 WISeR 帶來的逆風。是這樣嗎？

Or GLP-1s did come up, I think, towards the end of the prepared remarks. I'm not sure if you're baking in a little bit of more conservatism for those or if you're seeing anything from a competitive standpoint. But just would love just to, I guess, kind of flesh out all those different components.

另外 GLP-1 也被提到，我記得是在事先準備的發言接近尾聲時。我不確定你們是否把對這部分的更保守假設納入，或是你們在競爭面上看到了一些影響。但我很希望能把這些不同的組成因素再釐清一下。

Yes. Adam, it's Matt. I'll jump in on that one. So yes, I think if you do the math from where we started at the beginning of the year on our outlook and then what it's implied now and you say the $120 million to $150 million is due to some of the reimbursement headwinds, there's a gap there. It's a smaller gap, obviously, but there's a gap. And that's coming from a number of different things.

是的。Adam，我是 Matt。我來回答這題。所以是的，我認為如果你從年初我們的展望起點去計算，再對照現在隱含的數字，並且你說其中 1.2 億到 1.5 億美元是由於一些報銷逆風造成的，那中間確實還有一個落差。當然那個落差比較小，但確實存在。而這是由多個不同因素造成的。

Some of those are hard to put your finger on. We do think we're being impacted by GLP-1s, but harder to put your finger on what's driving some of that other impact, but we definitely think that the main part of the revenue takedown in our outlook is due to the reimbursement headwinds.

其中有些因素很難明確指出。我們確實認為 GLP-1 對我們有影響，但較難精準判斷其他影響是由什麼驅動；不過我們也很明確地認為，這次展望中營收下修的主要部分，是由報銷逆風所致。

Chris Pasquale, Nephron Research.

Chris Pasquale，Nephron Research。

Tim, I was hoping you could talk a little bit more about the current state of the sales force. Your US territory count has contracted three quarters in a row. It's now down high teens from where you were a year ago, which is a pretty big adjustment.

Tim，我希望你能再多談一點目前銷售團隊的狀況。你們美國的銷售區域（territory）數量已連續三個季度縮減。現在相較一年前已下降到十幾個百分點的幅度，這是相當大的調整。

How much of that has been an intentional rethinking of your commercial organization versus unplanned attrition? And are you kind of simultaneously dealing with new reps or reps with expanded territories having to establish new relationships while you're going through this period where your customers kind of need you even more?

其中有多少是你們有意重新思考商業組織所做的調整，而不是非計畫性的流失（attrition）？另外，你們是否同時也在面對：新業務或負責範圍擴大的業務需要建立新關係，而你們又正處於一段客戶其實更需要你們的時期？

Got you. Thanks, Chris. We do see adjustments in the field. And yes, it's a combination of both factors that you talked about. We did our own adjustments with our realignment of our territories, as you described and also increase in the number of field clinical reps wanting to get our ratio back to one is to one. That's the beginning of the year. I think we performed pretty well with that in the first quarter by achieving the implants and the revenue that we did, albeit, as Matt mentioned, impacted by the coding and the reimbursement environment as well as WISeR in those six states.

了解。謝謝，Chris。我們確實看到前線團隊的調整。而且是你提到的兩個因素的組合。我們如你所述，透過重新劃分區域做了我們自己的調整，同時也增加了前線臨床代表（field clinical reps）的人數，希望把比例拉回到一比一。這是在年初開始的。我認為我們在第一季表現相當不錯，達成了我們的植入量與營收；儘管如 Matt 提到的，也受到編碼與報銷環境，以及那六個州 WISeR 的影響。

I think it's purposeful for where we are, and we'll continue to add territory managers as we deem appropriate. But I think the field team is doing quite well. We have a pretty experienced team right now and then complementing those sales territory managers along with a strong field clinical representative, I think we're handling that very well and allows us to address issues such as this coding and reimbursement uncertainty.

我認為這是符合我們目前所處階段的有意為之，我們也會在認為適當時持續增聘區域經理（territory managers）。但我認為前線團隊目前做得很好。我們現在有一支相當有經驗的團隊，並以強而有力的前線臨床代表來支援這些銷售區域經理；我認為我們把這件事處理得很好，也讓我們能夠應對像這次編碼與報銷不確定性這類問題。

Anthony Petrone, Mizuho Financial Group.

Anthony Petrone，瑞穗金融集團（Mizuho Financial Group）。

Maybe sticking with WISeR here specifically. It's across 6 states. It sounds like there's a higher prior authorization hurdle here. But are those procedures should we kind of consider those backlog? Or are they sort of just pushed out indefinitely as you navigate WISeR? And then just building on the codes, the CPT codes, some of these policies are -- the managed care policies specifically still have the Inspire IV code. They've introduced 999, why is it not just the case that they can bill to the code and the policy? Why is there ambiguity? Sorry for the two-part question there.

也許就 WISeR 這點來問得更具體一些。它涵蓋 6 個州。聽起來事前授權的門檻更高。但這些手術我們是否應該把它們視為積壓（backlog）？還是說在你們因應 WISeR 的過程中，它們只是被無限期往後延？另外再延伸到代碼（codes），CPT 代碼方面，其中一些政策——特別是商業保險（managed care）政策——仍然有 Inspire IV 代碼。他們已引入 999，為什麼不能就直接依照代碼與政策去申報？為什麼會有模糊地帶？抱歉這是一個兩段式問題。

No, that's okay. That's great. WISeR, as you mentioned, with the prior authorization, previously, in the other non-WISeR states, Medicare does not prior authorize. So this is a new requirement that was placed on centers starting middle of January. And we believe the majority of those patients exist. But as time goes on, they may get frustrated. That's why we want to act quickly.

不會，沒關係。問題很好。如你提到的，WISeR 的事前授權方面，在其他非 WISeR 州，Medicare 先前是不做事前授權的。因此這是一項新的要求，從一月中旬開始加諸在各中心。我們相信大多數這些病患是存在的。但隨著時間推移，他們可能會感到挫折。這也是為什麼我們想要快速行動。

As we submit prior authorizations, we continue to learn and centers are able to provide improvements in those prior authorizations to ask questions or be able to understand the WISeR requirements that they're placing on them. And what we've learned is all 6 of the WISeR states have a different system, and there's variability in each. So we're trying to work through that and the sites and ourselves are getting smarter to be able to work with WISeR in a more efficient manner.

當我們提交事前授權時，我們也持續學習，而各中心也能在這些事前授權上做出改善，提出問題，或更理解 WISeR 對他們提出的要求。我們學到的是，6 個 WISeR 州各自都有不同的系統，而且每個州之間存在差異。因此我們正努力把這些流程跑順，而各據點與我們也都在變得更熟練，以便能更有效率地與 WISeR 合作。

As far as CPT coding goes, yes, these are contracted rates with both facilities and payers. Payers want to have centers work within their policies, and that's what we're recommending as well. And as we mentioned before, the good news is that these patients do carry a prior authorization. So when we submit the initial application, it does have the CPT code that will be used during the procedure.

至於 CPT 編碼，是的，這些是與醫療機構與付款方（payers）之間的合約費率（contracted rates）。付款方希望各中心在其政策範圍內運作，而這也是我們所建議的。而且如我們先前提到的，好消息是這些病患確實會有事前授權。因此當我們提交初始申請時，其中會包含手術時將使用的 CPT 代碼。

And once we receive approval, that really kind of prevents a lot of post-procedure challenges. And using a 64999 code is confusing because it does take additional work. It does take manual reviews. It does take additional communication from the sites to the payers. So I think right now, we continue to work with centers and payers and use the codes that are in the existing policies.

而且一旦我們取得核准，這確實能在很大程度上避免許多術後的挑戰。而使用 64999 代碼會讓人困惑，因為它確實需要額外的工作。它確實需要人工審查。它確實需要醫療院所與付款方之間額外的溝通。所以我認為目前我們會持續與醫療中心與付款方合作，並使用現行政策中既有的代碼。

Travis Steed, Bank of America.

Travis Steed，美國銀行。

On the $20 million impact, maybe if you could kind of go through some of the math behind that. There's a lot of factors you're calling out, but curious how do you kind of get confidence in that $20 million number. And when you look at the prior auths like are they just billing 64568 for commercial? Just curious why prior auths are dropping if they can just build the 64568 for commercial, especially given UnitedHealthcare, I think, just moved April 1 as well to that code.

關於 2,000 萬美元的影響，也許你可以稍微帶我們看一下背後的計算方式。你提到很多因素，但我想了解你們如何對這個 2,000 萬美元的數字建立信心。另外，當你看事前授權時，他們是否只是針對商業保險開立 64568 來請款？我也好奇，如果商業保險可以直接用 64568 來請款，為什麼事前授權會下降，尤其是我認為 UnitedHealthcare 也在 4 月 1 日改用那個代碼了。

Yes, Travis, this is Matt. Maybe I'll take the first half of that question, Tim grab the second one. So yes, obviously, there's lots of $20 million is an estimate. We've got some data, and we're triangulating some different trends in the business to come up with that, looking at data we've got quarter-over-quarter and versus last year and our expectations coming into the year. So it's a way for us to triangulate it. Obviously, there's estimation involved with that, and we think we're triangulating it to $20 million in a reasonable range.

是的，Travis，我是 Matt。也許我先回答問題的前半段，Tim 再接後半段。所以是的，很明顯地，2,000 萬美元是一個估算。我們有一些數據，並且透過交叉驗證（triangulate）業務中的不同趨勢來得出這個數字，會看我們掌握的季度對季度、與去年同期的數據，以及我們在年初對今年的預期。所以這是我們用來交叉驗證的一種方式。當然其中包含估算成分，而我們認為把它交叉驗證到約 2,000 萬美元、落在合理區間內。

As far as the commercial payers, you're correct that when we support centers with doing the prior authorizations, we use the code that's in the policy. And you're correct, UnitedHealthcare just adopted 64568 into their policy. And so we don't expect a lot of the commercial policies to move away from that.

至於商業保險付款方，你說得沒錯，當我們協助醫療中心進行事前授權時，我們會使用政策中所列的代碼。而你也說得對，UnitedHealthcare 剛把 64568 納入其政策。因此我們不預期多數商業保險政策會從該代碼移開。

Although the whole coding and reimbursement environment put challenges on the centers to understand what code that they want to use and it caused a slowdown that we see with the reduction of prior authorizations. The implants -- commercial implants in the first quarter tend to be the prior authorizations submitted in the fourth quarter that were not completed within that quarter. And so that kind of drove a lot of the revenue.

不過整體編碼與給付環境，確實讓醫療中心在理解要使用哪個代碼上面臨挑戰，也因此造成我們看到事前授權減少、進度放緩。第一季的植入量——商業保險的植入——往往是第四季提交但未能在該季完成的事前授權案件。因此那在很大程度上帶動了營收。

And now the implants in the second quarter are going to be reflective of the centers slowing down to make sure they understand the coding coverage situation before they ramp up submission of commercial cases. And with that, we believe we're going to continue to gain confidence, and that's what you'll see will continue to improve here in the second quarter and beyond through the continuation of the year.

而第二季的植入量將反映出醫療中心放慢腳步，以確保在加速提交商業案件之前，他們已充分理解編碼與給付涵蓋的情況。基於此，我們相信我們會持續建立信心，而你們將會看到在第二季以及之後、隨著今年持續推進，情況會持續改善。

Lawrence Biegelsen, Wells Fargo.

Lawrence Biegelsen，富國銀行。

Tim, one, I guess, technical coding and reimbursement question. So the 10-Q states that the MACs identify CPT code 64582 as the appropriate code for Inspire V, but commercial payers continue to pay 64568. Why would there be a different code for Medicare and commercial payers? Is this common to have 2 different codes? And the 10-Q also states that it's -- you believe that it's appropriate to bill 64582 without a modifier, but 64582 includes a respiratory sensor. So why would it not be appropriate to use a modifier as you expected, I think, on the Q4 call?

Tim，我有一個偏技術性的編碼與給付問題。10-Q 表示 MACs 認定 CPT 代碼 64582 是 Inspire V 的適當代碼，但商業保險付款方仍持續支付 64568。為什麼 Medicare 與商業保險付款方會使用不同的代碼？同時存在兩個不同代碼是常見的嗎？另外，10-Q 也提到你們認為 64582 不需要加註修飾碼（modifier）即可請款，但 64582 包含呼吸感測器。那為什麼不需要使用修飾碼？我記得你們在第四季電話會議上原本預期需要使用修飾碼。

I think -- Larry, thank you. I think your question really kind of laid out the coding and reimbursement uncertainty in the quarter. And with an ideal situation long-term with the new CPT code, Medicare, Medicare Advantage, commercial will all use the same CPT code. Where we are today, we do have that variance. And with the MACs currently identifying 64582 for physicians to bill, and they understand that the work related to Inspire IV and V for the pressure sensor is that not that significant and the Medicare difference in payment is only $70 between the two procedures. And so they have updated their local coverage determinations to not specify the use of a modifier and for surgeons to use 64582 for both the Inspire IV and Inspire V cases.

我想——Larry，謝謝。我想你的問題其實正好點出了本季在編碼與給付上的不確定性。從長期理想狀況來看，隨著新的 CPT 代碼，Medicare、Medicare Advantage、以及商業保險都會使用同一個 CPT 代碼。但就目前而言，我們確實存在這種差異。而目前 MACs 指出醫師應以 64582 來請款，他們也理解與 Inspire IV 與 V 的壓力感測器相關的工作量差異並不大，且兩項手術在 Medicare 的給付差異只有 70 美元。因此他們已更新其地方給付決定（LCD），不再指定需要使用修飾碼，並讓外科醫師在 Inspire IV 與 Inspire V 的病例都使用 64582。

Back a little bit overlapping, Travis asked a good question with commercial payers, why would they move away from 64568. And the answer is they don't really have to. That is the -- what they have in their policy, it's the contracted rates that they have with the centers, and we expect that we will stay 64568 as long as they're in the policies and recommend centers follow the policies and submit prior authorizations to policies. So it does cause some confusion, as you can imagine, with the payers within the system. And it's just simply not typical.

再回到一點重疊的部分，Travis 問了一個關於商業保險付款方的好問題：為什麼他們會從 64568 移開。答案是他們其實不需要。那是——他們政策裡既有的內容，也是他們與醫療中心之間的合約費率；我們預期只要政策仍包含 64568，我們就會維持使用 64568，並建議醫療中心遵循政策、依政策提交事前授權。所以你可以想像，這確實會在體系內的付款方之間造成一些混亂。而這種情況確實不常見。

You just don't see events like this, and it really puts us in a unique situation and every center kind of views it a little bit differently. But I think we're gaining experience with it. And that's why we believe with the prior authorization, we'll see challenges in the second quarter, but be able to build through that in the second half of the year and get back to growth in 2027.

你幾乎不會看到這種事件，這也讓我們處於一個很特殊的情境，而每一家醫療中心對此的看法也略有不同。但我認為我們正在累積經驗。因此我們相信在事前授權方面，第二季仍會看到挑戰，但我們能在下半年逐步克服，並在 2027 年回到成長軌道。

Richard Newitter, Truist Securities.

Richard Newitter，Truist Securities。

Tim, just on your last comment there, I think you said there were a few MACs where you're saying they updated to, say, 64582, but no modifier required. I guess in most instances, they had 64582 and there was nothing about a modifier, but they never updated to 64568 to begin with. So I guess when they put out their updated policies, technically, they're not -- there is no update. So what gives you the confidence to say that those policies are updated saying you don't need to use a modifier? And is there a risk that they could change to use a modifier?

Tim，針對你剛才最後的評論，我想你說有幾家 MACs 更新為例如 64582，但不需要修飾碼。但我理解在多數情況下，他們原本就只有 64582，而且從一開始就沒有更新到 64568。所以我想當他們發布更新政策時，嚴格來說其實並沒有——沒有更新。那你憑什麼有信心說那些政策已更新、表示不需要使用修飾碼？另外，他們是否有可能改成要求使用修飾碼的風險？

Sure. Very good comment, Rich, and thank you. If I misspoken, I think I probably did. The LCDs identify 64582 as the only code. And they don't say do not use a modifier. They just are silent on that and they don't have any language in there on a modifier. There are three MACs who have updated to include the new C-code but remain silent on any modifier. There are several other MACs who you are correct, did not switch over to 64568.

當然。Rich，你的評論很好，謝謝。如果我剛才說錯了，我想我可能確實說錯了。LCD 只把 64582 認定為唯一的代碼。而且他們並沒有說「不要使用修飾碼」。他們只是對此保持沉默，裡面沒有任何關於修飾碼的文字。有三家 MACs 已更新以納入新的 C-code，但對任何修飾碼仍保持沉默。另外還有幾家 MACs，如你所說，確實沒有轉到 64568。

But at this point, there is no MAC that identifies the use of a modifier with Inspire V cases, and they remain silent on that. Is there a risk to it if they want to come back and review this in the future, that's something that we will continue to monitor and we'll certainly monitor if there are surgeons who have used a modifier and what template they used and is there any or what level of reduction there was with the payment between the 2. But we do know that the difference in payment between 64582 and 64568 is only $70. Just checking back with you, Rich, if that makes sense?

但截至目前，沒有任何一家 MACs 指出 Inspire V 病例需要使用修飾碼；他們對此仍保持沉默。至於未來如果他們想回頭檢視、是否存在風險，這是我們會持續監控的事項；我們也會確實追蹤是否有外科醫師使用了修飾碼、他們使用了哪種範本，以及兩者之間的給付是否有任何、或是何種程度的減少。但我們確實知道 64582 與 64568 的給付差異只有 70 美元。Rich，我再跟你確認一下，這樣說是否合理？

That does, thank you and then just what's your definition of growth for '27? And I appreciate '26 is hard enough. So I'm not asking you to pinpoint us on '27, but you did say a return to growth in '27. It's an opportunity to kind of corral the sheep, if you will. Any -- where would you presume consensus should fall? Or what's your definition of growth at this juncture to be prudent?

了解，謝謝。那你對於『27 年的成長』定義是什麼？我也理解『26 年已經夠難了。所以我不是要你精準預測『27 年，但你確實提到『27 年會回到成長。這算是一個把羊群趕回來的機會，如果你願意這麼說的話。那麼——你認為市場共識應該落在哪裡？或者在目前這個時間點，為了審慎起見，你對成長的定義是什麼？

Yes. Thanks, Rich. We have to be careful with that because we have a lot of work to do, as you've heard from several of the questions right before here in our prepared remarks on working through and getting consistency and confidence in the coding and reimbursement environment to allow centers to open up and increase their utilization again is really kind of our focus and keep asking that question through the year as we go, and we'll provide updates to it. But we are committed to getting back to growth. We just got to be careful about really kind of putting too much of a detail to that.

是的。謝謝，Rich。我們必須對此保持謹慎，因為我們還有很多工作要做；正如你從前面幾個問題以及我們事先準備的講稿中聽到的，我們的重點其實是把編碼與給付（reimbursement）環境的流程跑順，建立一致性與信心，讓中心能夠重新開放並提高使用量。我們會在今年持續反覆檢視這個問題，並提供更新。但我們確實承諾要回到成長。只是我們必須小心，不要把細節講得過於具體。

Michael Polark, Wolfe Research.

Michael Polark，Wolfe Research。

I'm interested in an update on the Inspire IV versus V mix. Tim, I heard you say you still have inventory of IV for centers that have concerns about V billing. Where does that stand? And is the company thinking about maybe reinvesting in IV to navigate this difficult period?

我想了解 Inspire IV 與 V 的組合占比更新。Tim，我聽到你說你們仍有 IV 的庫存，提供給對 V 的帳務申報（billing）有疑慮的中心。目前情況如何？公司是否在考慮重新加大對 IV 的投入，以度過這段艱難時期？

Sure. And we did build up inventory, as you probably saw from the financials. And so we do have good inventory of IV to be able to offer that. to centers in the US as well as to continue to support ongoing implants in Europe and Asia. But as we started the year and as we went through the first quarter, implants are predominantly Inspire V. And I think when centers start doing Inspire V, they want to work through the coding and reimbursement.

當然。而且我們確實增加了庫存，你從財報上應該也看得出來。因此我們有充足的 IV 庫存，能在美國提供給中心使用，同時也能持續支援歐洲與亞洲的既有植入手術。但今年一開始、以及第一季的進展來看，植入手術主要以 Inspire V 為主。我認為當中心開始做 Inspire V 之後，他們會希望把編碼與給付問題處理到位。

They want to have a solution to that. But there are centers that have different levels of Medicare reimbursement, as you know, from geographically adjusted that they do adopt, they continue with Inspire IV. But while we make it -- we're going to make it available to them. But I think once centers convert over to V, they kind of want to stay there. They just want confidence in having a good coding solution and to have proper reimbursement.

他們希望有一個解決方案。但如你所知，有些中心的 Medicare 給付水準因地區調整而不同，因此他們會採用並持續使用 Inspire IV。我們會——我們會讓它對他們保持可用。但我認為一旦中心轉到 V，他們通常會想留在 V。他們只是希望對於良好的編碼方案與能獲得適當給付有信心。

Mike, this is Matt. I'd just add to that. As Tim said, predominantly, the mix in Q1 was Vs, and that mix really didn't change very much from what we saw in Q4. So we're going to continue to monitor it. But so far, it's been predominantly Vs. And as Tim said, we've got inventory of IVs should that mix tick up a little bit.

Mike，我是 Matt。我補充一下。如 Tim 所說，第一季的組合占比主要是 V，而且這個占比與我們在第四季看到的相比並沒有太大變化。所以我們會持續監測。但到目前為止，仍以 V 為主。而且如 Tim 所說，如果這個占比稍微往 IV 方向上升，我們也有 IV 的庫存可供應。

Shagun Singh, RBC Capital Markets.

Shagun Singh，RBC Capital Markets。

Tim, I was intrigued that while you were providing your guidance, you indicated that it's based on some high-level assumptions. And this quarter, you're talking about the WISeR program a little bit more than you have in the past. I think some of our checks were suggesting there could be a little bit of overutilization there. And then you're also mentioning GLP-1s.

Tim，我注意到你在提供財測指引時提到它是基於一些高層次假設。而且這一季你談到 WISeR 計畫的篇幅比過去更多。我想我們的一些調查顯示，那裡可能存在一些過度使用（overutilization）。另外你也提到了 GLP-1。

And some of our checks were suggesting that it's driving a bit of a lag between when patients do come in eventually to get the Inspire therapy, and it could be over a year. So can you put a finer point on your -- just the comment around returning back to growth. Why should you return back to growth any time before January 1, 2028, when you do have a new code?

而我們的一些調查顯示，這可能導致病人最終來接受 Inspire 治療的時間點出現一些延後，甚至可能超過一年。所以你能否更精準地說明你——關於回到成長的那段評論？為什麼你們應該能在 2028 年 1 月 1 日之前回到成長？畢竟你們要到那時才會有新的代碼（code）。

I think the -- as Matt went through in his comments, the impact on our revenue this year and -- which is reflected in our updated guide is really based on coding and reimbursement uncertainty as well as negative impact from the WISeR program and delaying procedures due to prior authorization. We make mention of the GLP-1s as a broader topic, but not specifically having a significant part of that revenue adjustment.

我想——如 Matt 在他的評論中所說，我們今年營收的影響——也反映在我們更新後的指引中——主要是基於編碼與給付不確定性，以及 WISeR 計畫的負面影響，還有因事前授權（prior authorization）而延後手術。我們提到 GLP-1 是作為更廣泛的議題，但並未將其視為這次營收調整中的重大部分。

And I think if we can focus our activities on gaining confidence with a solid methodology for coding and reimbursement and continue to learn to work with the WISeR systems to gain prior authorizations that we can continue to see improvements through the year to get back to a growth situation.

我認為，如果我們能把活動重點放在建立一套穩健的方法論，以提升對編碼與給付的信心，並持續學習如何與 WISeR 系統合作以取得事前授權，我們就能在今年逐步看到改善，回到成長的狀態。

David Rescott, Baird.

David Rescott，Baird。

Great. Tim, you mentioned, I think, a couple of times that despite this uncertainty, the company is continuing to prioritize investing in these revenue-generating activities. And so when I think about the existing accounts that potentially are revenue generating and the prior algorithm for growth of adding new accounts, is it fair to assume that the focus at this point is primarily on the accounts that you have today where you can capture that untapped or push through some of those revenue opportunities?

很好。Tim，你提到我想你講了幾次，儘管存在這些不確定性，公司仍持續優先投入這些能帶來營收的活動。因此當我思考現有帳戶（accounts）可能帶來的營收，以及過去透過新增帳戶來成長的既有策略時，是否可以合理假設，目前的重點主要放在你們今天已經擁有的帳戶上，以捕捉那些尚未開發的、或推進其中一些營收機會？

Or should we assume as we're looking into the back half of the year and into 2027 that still bringing on new accounts maybe is a way in which you expect to grow next year? Just any more granularity on those prioritized investments would be helpful.

或者我們是否應該假設，當我們展望今年下半年以及 2027 年時，持續導入新帳戶也可能是你們預期明年成長的方式之一？如果能對這些優先投資項目提供更細的說明會很有幫助。

Thank you, David. The answer is both. And I think you asked a very clear question on do we focus on existing centers. And the number one focus area is to make sure our existing centers have a solid pathway in coding and reimbursement. I know we've repeated this over and over.

謝謝你，David。答案是兩者都會。我認為你問得很清楚：我們是否聚焦在既有中心。第一優先事項是確保我們現有中心在編碼與給付上有一條清晰且穩固的路徑。我知道我們一再重複這點。

But once that is in place and they understand how they can code both Medicare, Commercial, and Medicare Advantage and they have confidence in the reimbursement that they're going to receive that they can increase the use of Inspire therapy, and we'll be able to see that with increased prior authorization submissions and the ability to take on more patients.

但一旦這些到位，而且他們了解如何針對 Medicare、商業保險（Commercial）以及 Medicare Advantage 進行編碼，並且對他們將收到的給付金額有信心，他們就能提高 Inspire 治療的使用量；我們也會從事前授權申請量的增加，以及承接更多病人的能力上看到這一點。

As we work through this, the inherent question in there is the challenges of opening new centers in the first quarter with this coding uncertainty also existed, but we're going to continue to lean into that because we still don't have the capacity to treat the patient demand that we have. And so we will continue to open new centers or train additional surgeons at existing sites.

在我們處理這些問題的同時，其中隱含的問題是：第一季在這種編碼不確定性下，開設新中心也面臨挑戰；但我們仍會持續推進，因為我們目前仍沒有足夠的產能來滿足現有的病人需求。因此我們會持續開設新中心，或在既有據點培訓更多外科醫師。

And that was one of the key benefits that we talked about with Inspire V last year but have been unable to kind of lean into until we get the coding taken care of. So yes, the priority is certainly open up and increased utilization at existing centers, but we are still going to be leaning in to open new centers as well.

而這也是我們去年談到 Inspire V 的一個關鍵優勢，但在把編碼問題處理好之前，我們一直無法真正充分發揮。所以是的，優先順序當然是讓既有中心開放並提高使用量，但我們也仍會持續推進開設新中心。

Michael Sarcone, Jefferies.

Michael Sarcone，Jefferies。

Tim, you talked about getting accounts comfortable with the billing and coding situation. I guess what does it take? I know this can vary by account. But when you think about it, what does it take to get an account comfortable? Do they have to submit one and then maybe wait for reimbursement and then submit 2 more? And I guess, how long does it take for the average account to get comfortable here?

Tim，你談到要讓各帳戶對帳務申報與編碼情況感到安心。我想問的是，需要做到什麼程度？我知道這會因帳戶而異。但從你的角度來看，要讓一個帳戶感到安心，需要哪些條件？他們是否必須先送出一筆申報，然後可能等到拿到給付後再送出另外兩筆？另外，一般而言，一個平均帳戶需要多久時間才能在這方面感到安心？

It's experience. And so what we do is we make sure that we proactively conduct business reviews with centers. We want them to understand what the coding and billing is. And as we mentioned from prior questions with Larry about one code for Medicare, a different code for commercial. And to make sure that the coding personnel at the facility understands what the right code is to use to be able to send that code in and then closely monitor the payment when it comes back or if it's denied, did it have to go back to an appeal to be able to do that.

這是經驗的累積。因此我們所做的是，確保我們會主動與各中心進行業務回顧。我們希望他們了解編碼與帳單申報是怎麼回事。而且如同我們先前在與 Larry 的提問中提到的，Medicare 用一個代碼，商業保險用不同的代碼。並確保院所的編碼人員了解應使用的正確代碼，能夠把該代碼送出申報，並在回款時密切監控付款情況；若遭拒付，是否需要回到申訴流程才能完成。

So as we work through the first quarter, we're starting to pick up that experience, and we're going to continue to lean in on that as we work through the year. And that's what we define kind of as confidence in their coding. Once they have a methodology and see they have a good pathway with the bridge that we're establishing to the new CPT code. And if we have some consistency there, we can really ramp up. And I guess it's simply having experience with positive experience with their coding processes.

因此在我們推進第一季的過程中，我們開始累積這些經驗，並且在今年接下來的時間裡會持續加大投入。這就是我們所定義的、對他們編碼的信心。一旦他們有了方法論，並看到我們正在建立通往新 CPT 代碼的橋接有一條良好的路徑。而如果我們能在那裡取得一些一致性，我們就能真正加速放量。我想這本質上就是在他們的編碼流程上累積經驗，且是正向的經驗。

Yes. The only thing I'd add to that is a lot of what's experiencing our customers is fairly unique. So it's really understanding what their challenge is and how we can help them. It's not a kind of a broad one-size-fits-all solution across our customer base. So it's really -- for us, it's important we work with our customers and help them in the challenges that they're having.

是的。我唯一想補充的是，我們客戶正在經歷的很多情況相當獨特。所以重點在於真正理解他們的挑戰是什麼，以及我們如何幫助他們。這不是一種可套用到所有客戶的、廣泛的一體適用解決方案。因此對我們而言，重要的是與客戶合作，協助他們解決正在面臨的挑戰。

Brett Fishbin, KeyBanc Capital Markets.

Brett Fishbin，KeyBanc Capital Markets。

I was just hoping you could address the competitive landscape, mainly with a competitor now being launched for a few quarters here in the US. Just wondering if you're seeing maybe an impact from centers trialing the new device or shifting their mix in any tangible way and then how you've updated the guidance to account for any changes there?

我只是希望你們能談談競爭態勢，主要是因為有一個競爭對手的產品在美國已經上市了幾個季度。想請問你們是否看到中心在試用新裝置或以任何可量化的方式調整其產品組合，進而造成影響？以及你們如何更新指引以反映那邊的任何變化？

Definitely, Brett. I think that when we did our initial guidance out there, we made note that, yes, there was a competitive presence out there. I think with the coding and the reimbursement uncertainty and then certainly in the 6 states with the WISeR accounts, I think we're really focused on addressing those 2 key challenges. And that predominantly drives the actions of the centers, much less having the ability to introduce a new topic. So I think all the centers are really focused on that as our team is, and we're going to continue to stay there as we work through the second quarter and through the duration of the year.

當然可以，Brett。我認為當我們最初提出指引時，我們就已指出，是的，市場上確實存在競爭者。我認為在編碼與給付不確定性之下，並且特別是在有 WISeR 帳戶的 6 個州，我們真正聚焦在解決這兩個關鍵挑戰。而這些因素在很大程度上驅動了各中心的行動，相較之下，他們較難再引入一個新的議題。所以我認為所有中心都非常專注於此，就像我們團隊一樣；我們會在推進第二季以及今年剩餘期間持續聚焦在這裡。

And Brett, I would say we didn't introduce anything new in terms of some of the revised outlook specifically related to competition.

而且 Brett，我會說我們在修正後的展望中，並沒有新增任何特別與競爭相關的內容。

Daniel Markowitz, Evercore ISI.

Daniel Markowitz，Evercore ISI。

I just wanted to follow up on the question on what will it take for centers to feel like they have a handle on this. I guess what gets you confident that we can get to the point that these centers are comfortable before there is coding uniformity across payer types. And then just a brief follow-up on that. Could we possibly see some pent-up as we potentially return to hopeful growth in 2027, just given that the number of procedures have been sort of put on hold?

我想跟進一下關於中心需要什麼才會覺得自己已經掌握狀況的問題。我想問的是，在不同付款方類型之間尚未達到編碼一致性之前，是什麼讓你們有信心能走到讓這些中心感到安心的程度？然後再簡短追問一下。考量到一些手術量已經某種程度被暫緩，若我們在 2027 年可能回到較有希望的成長，是否可能看到一些被壓抑的需求釋放？

Yes. Let me answer the last one first and kind of work back to getting confidence with centers. I do think that centers understand when they are able to do Inspire V procedures, the benefits that, that may have and their ability to take care more patients as the procedure is more comfortable for an ENT surgeon as compared to an Inspire IV. And again, we haven't had the ability to really lean in on that and really push the clinical evidence that comes with the Inspire V procedure and I think that, that will be in the future. And I think that will kind of help with the growth in '27 and beyond, certainly.

是的。我先回答最後一個問題，然後再回到如何讓中心建立信心。我確實認為，中心明白當他們能夠進行 Inspire V 手術時，這可能帶來的效益，以及他們能照護更多病人的能力，因為相較於 Inspire IV，這項手術對耳鼻喉科（ENT）外科醫師而言更為舒適。同樣地，我們目前還沒有真正能夠在這方面大力投入，去推動 Inspire V 手術所帶來的臨床證據；我認為那會在未來發生。而我認為那將有助於 2027 年及之後的成長，當然。

But again, it's just experience with centers to be able to submit cases and see positive acceptance of prior authorizations, positive acceptance of billing using the new coding methodology and then certainly receiving expected payment or expected reimbursement, and that will continue to grow confidence and allow us to open the gates more and continue to increase volume.

但再說一次，關鍵就是中心的經驗：能夠送出個案，並看到事前授權獲得正向核准、使用新的編碼方法進行帳單申報獲得正向接受，並且確實收到預期的付款或預期的給付；這些都會持續建立信心，讓我們能更大幅度地開闢通路並持續提高量能。

Mike Kratky, Leerink Partners.

Mike Kratky，Leerink Partners。

Maybe just to drill down on rest-of-year cadence and growth implications. I mean you provided some helpful color on the second quarter and the dollar impact from reimbursement and WISeR. So what are going to be the key points of sensitivity that could get you to the high end versus low end of the range in 3Q and 4Q?

也許再深入談談今年剩餘時間的節奏與成長意涵。你們對第二季以及給付與 WISeR 的金額影響提供了一些有用的說明。那麼在第三季與第四季，哪些關鍵敏感因素會讓你們落在區間的高端或低端？

Yes. I think the main thing as we've been talking about is how quickly that we can move customers through their challenges with coding and reimbursement, right? So if some of those remain for longer periods, then you're looking at the higher end of the range. If customers are able to move through that quickly -- more quickly, then you're looking at the lower end of the range.

是的。我認為主要重點如同我們一直在談的：我們能多快協助客戶克服其在編碼與給付上的挑戰，對吧？因此如果其中一些問題持續更久，那你就會落在區間的高端。如果客戶能更快地走過這段過程——更快地解決，那你就會落在區間的低端。

Thanks, Mike. Thanks all for joining the call today. As always, I'm grateful to our team of dedicated employees for their enthusiasm, hard work and continued motivation to achieve successful and consistent patient outcomes. The team's commitment to patients remains unmatched and is the most important element to our success. For all of you on the call, we appreciate your continued interest in and support and look forward to providing you with further updates in the months ahead.

謝謝你，Mike。也謝謝各位今天參加電話會議。一如既往，我很感謝我們敬業的員工團隊，他們以熱忱、努力工作並持續保持動力，來達成成功且一致的病患治療結果。團隊對病患的承諾無可匹敵，也是我們成功最重要的要素。對於線上各位，我們感謝你們持續的關注與支持，並期待在接下來幾個月為各位提供更多更新。

Thank you. This concludes today's conference call. You may all disconnect.

謝謝。今天的電話會議到此結束。各位可以掛線。