Waystar reported fourth-quarter revenue of $304 million, up 24% year-over-year and 12% organically, and adjusted EBITDA of $129 million, a 29% increase, delivering a 43% margin. The company ended the period with $86 million in cash equivalents, $1.5 billion in gross debt, unlevered free cash flow of $80 million, and net leverage at 3x.

The Iodine acquisition contributed $31 million in Q4 revenue, slightly above expectations, and added over 1,000 hospitals and health systems with only 35% customer overlap. Management now expects to capture over 90% of committed cost synergies in fiscal 2026, quantifying about $14 million in annualized savings ahead of plan.

Waystar’s Altitude AI prevented more than $15 billion in denials for clients, reduced appeal times by 90%, and achieved double-digit overturn rates. Approximately 50% of solutions leverage embedded AI, accounting for 40% of revenue and 30% of 2025 new bookings, with multiple new AI agents slated for release this year.

For fiscal 2026, Waystar guided revenue of $1.274–1.294 billion (17% growth) and adjusted EBITDA of $530–540 million (16% growth) with a 42% margin and gross margins near 68%. Management anticipates annual deleveraging of about one turn and steady sequential revenue gains throughout the year.