HTFL · Heartflow

The thesis

Heartflow's shares are modestly more likely than not to beat the S&P 500 over the next three months. The company reported on 12 November 2026 that revenue growth accelerated to 57% and raised its 2026 outlook for a third time. The 19.13% fall in the 13 November 2026 session took the shares back below their 50-day average. No change in reported results came with it. The fourth-quarter report, expected around mid-March 2027 with the first 2027 outlook, will show whether growth carries into next year.

The rating is medium because results and guidance support the case, and a high bar for 2027 holds it back. Four brokers raised their price targets on 13 November 2026, per Benzinga and fiscal.ai. Stifel went to $70 from $45, Wells Fargo to $70, Canaccord Genuity to $69 from $56 and Baird to $68. Against that, the shares trade at 15.1 times book value at the 13 November 2026 close, and the company still loses money.

The fall followed a debate about the fourth quarter. On the 12 November 2026 call, an analyst said the outlook implied a fourth-quarter slowdown, per the Investing.com transcript. Chief financial officer Vikram Verghese answered that the guide implies nearly 37% FFRct volume growth from a year earlier and keeps price assumptions unchanged. He said the company sets a baseline "that leaves sufficient room for outperformance." The case rests on the next report.

Bullish and bearish views on Heartflow, Inc.

The bull case on Heartflow, Inc. (HTFL), in brief: revenue growth sped up every quarter. The bear case: the market sold the beat.

Bull case

• Revenue growth sped up every quarter. Quarterly revenue grew 41.3% from a year earlier in the first quarter of 2026, 47.6% in the second and 57.4% in the third, per the company's 10-Q filings. Third-quarter revenue was $72.9 million, and U.S. revenue rose 60% to $67.9 million, per the 12 November 2026 release.
• Case volumes outran revenue. Total revenue cases were 98,155 in the third quarter, up 89.5% from a year earlier, per the 12 November 2026 call.
• Guidance raised a third time. On 12 November 2026 the company raised its full-year 2026 revenue outlook to $262–264 million from $246–250 million, about 49–50% growth. It raised non-GAAP gross margin guidance to about 82.5%. On the call, management put 2026 Plaque revenue at $36–37 million and said it expects about 1,300 Plaque-activated accounts by year-end, against "close to 500" at the start of 2026.
• Losses are narrowing fast. Third-quarter gross margin was 83.6%, against 76.5% a year earlier, and the operating margin was −19.0%, against −32.6%, per the 10-Q filed 12 November 2026. Adjusted EBITDA (earnings before interest, taxes, depreciation and amortization) was negative $3.6 million, against negative $9.8 million a year earlier. Management repeated its target of cash-flow break-even by mid-2028.
• Pricing and payment rise in 2027. On the 12 November 2026 call, the company said its next contractual price step-up takes effect in the first quarter of 2027. Chief executive John Farquhar cited an 11% increase in Medicare payment for coronary CT angiography (CCTA) going into 2027.
• Clinical data widen the use case. Heartflow reported on 1 November 2026 that its 1,105-patient P4 trial met its primary endpoint. One-year target-vessel failure was 4.1% with CT-guided planning of stent procedures (PCI, percutaneous coronary intervention), against 4.6% with intravascular ultrasound. On the 12 November 2026 call, management said it is preparing a broader 2027 rollout of PCI Navigator, the planning tool built on that data, after starting a collaboration with Boston Scientific in late October.

Bear case

• The market sold the beat. The shares fell 19.13% on 13 November 2026 while the S&P 500 fell 0.40%, per a Capp Notes market wrap that evening. The close of $48.46 erased the run from $52.40 on 6 November 2026 into the report.
• FFRct pricing gains slow from 2027. On the 12 November 2026 call, the chief financial officer said price gains from a year earlier for FFRct (fractional flow reserve derived from CT) will moderate from 2027. He also expects Plaque pricing to be roughly flat in the fourth quarter from the previous quarter.
• The company still burns cash. Net loss was $79 million over the four quarters to 30 September 2026, and free cash flow was negative $56 million, per the 10-Q filed 12 November 2026. The diluted share count was 77.7% higher than a year earlier.
• Officers keep selling. SEC Form 4 filings show the chief executive selling 38,900 shares at $55.74 on 10 November 2026 and the same number at $49.57 on 12 October 2026. The chief financial officer sold 3,587 shares at $53.15 on 9 November 2026, and chief medical officer Campbell Rogers sold 23,933 shares at $55.01 on 22 October 2026. All of these sales were under Rule 10b5-1 plans.
• Medicare physician rates fall in 2027. The Centers for Medicare & Medicaid Services (CMS) final rule of 4 November 2026 sets the 2027 conversion factor at $32.63 for non-qualifying participants, down 2.31% from $33.40. Cardiology groups said they were disappointed with the final rules, per Becker's.
• Rivals are close enough to sue. Heartflow sued Elucid Bioimaging on 22 October 2026 in the District of Massachusetts over trade secrets and patents. A separate April 2026 case against Cleerly is in the Eastern District of Texas.

Price setup

The shares closed at $48.46 on 13 November 2026. That is 20.1% below the 52-week intraday high of $60.66 set on 11 November 2026. Adjusted daily closes put the 50-day moving average at $51.91 and the 200-day at $35.21 as of 13 November 2026. The close sits below the first and well above the second. The three-month change is 15.5%.

The last close before the report was $59.92 on 12 November 2026. One session returned the shares to below the $52.40 close of 6 November 2026. The three-month reference close was $41.94 on 17 August 2026, the week after the second guidance raise, and the 52-week closing low is $20.49, from 13 March 2026. The gain since mid-August rests on two guidance raises and the third-quarter beat. A slide back toward mid-August prices would mean the market no longer credits them.

Single stocks move widely over three months. Across liquid US stocks, the standard deviation of 63-session returns was 27% in 2026, against 15% in 2017. For a company valued at $4,259 million on a quarterly revenue run of $73 million, a swing of that size around the fourth-quarter report is ordinary.

Catalysts ahead

• 1 January 2027: Calendar-year 2027 Medicare payment rules take effect, including the 2.31% physician conversion-factor cut. Shows whether the CCTA payment increase the chief executive cited on the 12 November 2026 call outweighs the lower physician rates in hospital scanning volumes.
• ~17 March 2027 (est.): Fourth-quarter and full-year 2026 results, with a first 2027 outlook. Shows whether full-year 2026 revenue reaches the raised $262–264 million range and whether the first 2027 outlook keeps growth near the 49–50% of 2026 as FFRct price gains slow.

What would change the view

A weekly close below $42, back to the $41.94 close of 17 August 2026, which would erase the three-month gain built on two guidance raises and the third-quarter beat. Full-year 2026 revenue below the $262 million low end of the raised outlook would also break the case.

The risks this note tracks, each with what would confirm it:

• Growth slows after three straight quarters of acceleration. Confirmed by: full-year 2026 revenue below the $262 million low end of the outlook, or a 2027 revenue outlook implying growth well below 2026's 49–50%.
• Slower FFRct price gains from 2027 drag revenue growth below volume growth. Confirmed by: first-quarter 2027 revenue growth trailing case-volume growth by a wider margin than the 57% revenue against 89.5% case growth of the third quarter of 2026.
• Medicare or insurer payment for coronary CT analysis falls. Confirmed by: a CMS proposed rule cutting payment for FFRct (CPT 75580) or plaque analysis (CPT 75577), or management reporting lost payer coverage.
• Officer selling weighs on the shares. Confirmed by: form 4 filings show officer sales outside Rule 10b5-1 plans, or sales growing beyond the chief executive's roughly monthly 38,900-share sales.
• Rivals such as Elucid and Cleerly slow Heartflow's growth or pricing. Confirmed by: management reports pricing pressure or slower new-account growth, or a rival wins a large health-system contract.
• The P4 result does not turn into PCI Navigator revenue. Confirmed by: the fourth-quarter report and 2027 outlook give no pricing, reimbursement or revenue figure for PCI Navigator.
• Patent and trade-secret litigation turns against Heartflow or becomes costly. Confirmed by: a court denies Heartflow's claims, a defendant successfully challenges the asserted patents, or legal expense lifts operating costs in reported results.

What it trades with

Heartflow has traded on its own news since its August 2025 Nasdaq listing. Its largest moves have come on guidance raises, trial readouts and earnings. On 13 November 2026 it fell 19.13% while the Nasdaq Composite fell 0.91%, per Capp Notes. A common market view is that unprofitable, fast-growing medtech shares move with appetite for growth stocks when they have no news of their own. CMS payment rules for coronary CT affect Heartflow alongside other cardiac-imaging companies, including the privately held rivals Cleerly and Elucid. The PCI Navigator collaboration ties part of its 2027 plan to Boston Scientific's interventional cardiology business.