Nevro (NVRO) 10-Q26 Apr 232023 Q1 Quarterly reportFinancial data

Company Profile

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
Document and Entity Information - shares	Mar. 31, 2023	Apr. 19, 2023
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2023
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q1
Trading Symbol	NVRO
Entity Registrant Name	Nevro Corp.
Entity Central Index Key	0001444380
Current Fiscal Year End Date	--12-31
Entity Filer Category	Large Accelerated Filer
Entity Current Reporting Status	Yes
Entity Small Business	false
Entity Shell Company	false
Entity Emerging Growth Company	false
Entity Common Stock, Shares Outstanding		35,817,154
Entity File Number	001-36715
Entity Tax Identification Number	56-2568057
Entity Address, Address Line One	1800 Bridge Parkway
Entity Address, City or Town	Redwood City
Entity Address, State or Province	CA
Entity Address, Postal Zip Code	94065
City Area Code	650
Local Phone Number	251-0005
Entity Interactive Data Current	Yes
Entity Incorporation, State or Country Code	DE
Security Exchange Name	NYSE
Document Quarterly Report	true
Document Transition Report	false
Title of 12(b) Security	Common Stock, $0.001 par value per share

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Current assets
Cash and cash equivalents	$ 64,227	$ 120,373
Short-term investments	277,539	254,012
Accounts receivable, net of allowance for doubtful accounts of $752 and $1,270 at March 31, 2023 and December 31, 2022, respectively	65,725	78,930
Inventories	113,293	99,638
Prepaid expenses and other current assets	14,673	9,984
Total current assets	535,457	562,937
Property and equipment, net	22,911	22,271
Operating lease assets	12,341	13,430
Other assets	3,109	3,164
Restricted cash	606	606
Total assets	574,424	602,408
Current liabilities
Accounts payable	29,229	26,849
Accrued liabilities	40,367	47,168
Other current liabilities	5,323	5,195
Total current liabilities	74,919	79,212
Long-term debt	187,175	186,867
Long-term operating lease liabilities	8,945	10,296
Other long-term liabilities	2,157	2,157
Total liabilities	273,196	278,532
Commitments and contingencies (Note 6)
Stockholders’ equity
Preferred stock, $0.001 par value, 10,000,000 shares authorized at March 31, 2023 and December 31, 2022; zero shares issued and outstanding at March 31, 2023 and December 31, 2022
Common stock, $0.001 par value, 290,000,000 shares authorized at March 31, 2023 and December 31, 2022; 36,376,936 and 36,203,423 shares issued at March 31, 2023 and December 31, 2022, respectively; 35,694,020 and 35,520,507 shares outstanding at March 31, 2023 and December 31, 2022, respectively	36	35
Additional paid-in capital	945,419	934,132
Accumulated other comprehensive income (loss)	(2,001)	(3,094)
Accumulated deficit	(642,226)	(607,197)
Total stockholders’ equity	301,228	323,876
Total liabilities and stockholders’ equity	$ 574,424	$ 602,408

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Accounts receivable, allowance for doubtful accounts	$ 752	$ 1,270
Preferred stock, par value	$ 0.001	$ 0.001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value	$ 0.001	$ 0.001
Common stock, shares authorized	290,000,000	290,000,000
Common stock, shares issued	36,376,936	36,203,423
Common stock, shares outstanding	35,694,020	35,520,507

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations and Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Income Statement [Abstract]
Revenue	$ 96,327	$ 87,842
Cost of revenue	31,703	28,750
Gross profit	64,624	59,092
Operating expenses
Research and development	14,755	12,536
Sales, general and administrative	86,192	79,325
Total operating expenses	100,947	91,861
Income (Loss) from operations	(36,323)	(32,769)
Interest income	3,278	143
Interest expense	(1,613)	(1,603)
Other income (expense), net	(46)	85
Income (Loss) before income taxes	(34,704)	(34,144)
Provision for income taxes	325	181
Net income (loss)	(35,029)	(34,325)
Other comprehensive loss:
Changes in foreign currency translation adjustment	506	(192)
Changes in unrealized gains on short-term investments, net	587	(1,021)
Net change in other comprehensive loss	1,093	(1,213)
Comprehensive income (loss)	$ (33,936)	$ (35,538)
Net income (loss) per share, basic	$ (0.98)	$ (0.98)
Net income (loss) per share, Diluted	$ (0.98)	$ (0.98)
Weighted average number of shares used to compute basic net (loss) per share	35,584,685	35,073,862
Weighted average number of shares used to compute diluted net (loss) per share	35,584,685	35,073,862

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Stockholders' Equity (unaudited) - USD ($) $ in Thousands	Total	Cumulative Effect, Period of Adoption, Adjustment [Member]	Common Stock [Member]	Additional Paid-In Capital [Member]	Additional Paid-In Capital [Member] Cumulative Effect, Period of Adoption, Adjustment [Member]	Accumulated Deficit [Member]	Accumulated Deficit [Member] Cumulative Effect, Period of Adoption, Adjustment [Member]	Accumulated Other Comprehensive Income (Loss) [Member]
Beginning balances at Dec. 31, 2021	$ 303,616	$ (34,345)	$ 35	$ 928,138	$ (48,340)	$ (624,193)	$ 13,995	$ (364)
Beginning balances, shares at Dec. 31, 2021			35,026,654
Accounting Standards Update [Extensible Enumeration]		us-gaap:AccountingStandardsUpdate202006Member			us-gaap:AccountingStandardsUpdate202006Member		us-gaap:AccountingStandardsUpdate202006Member
Exercise of common stock options	545			545
Exercise of common stock options, shares			10,642
Issuance of common stock upon release of restricted stock units, shares			263,412
Shares withheld for tax obligations	(7,298)			(7,298)
Shares withheld for tax obligations, shares			(107,257)
Stock based compensation	13,406			13,406
Net income (loss)	(34,325)					(34,325)
Change in other comprehensive loss	(1,213)							(1,213)
Ending balances at Mar. 31, 2022	240,386		$ 35	886,451		(644,523)		(1,577)
Ending balances, shares at Mar. 31, 2022			35,193,451
Beginning balances at Dec. 31, 2022	323,876		$ 35	934,132		(607,197)		(3,094)
Beginning balances, shares at Dec. 31, 2022			35,520,507
Issuance of common stock upon release of restricted stock units			$ 1	(1)
Issuance of common stock upon release of restricted stock units, shares			243,276
Shares withheld for tax obligations	(2,273)			(2,273)
Shares withheld for tax obligations, shares			(69,763)
Stock based compensation	13,561			13,561
Net income (loss)	(35,029)					(35,029)
Change in other comprehensive loss	1,093							1,093
Ending balances at Mar. 31, 2023	$ 301,228		$ 36	$ 945,419		$ (642,226)		$ (2,001)
Ending balances, shares at Mar. 31, 2023			35,694,020

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash flows from operating activities
Net income (loss)	$ (35,029)	$ (34,325)
Adjustments to reconcile net loss to net cash used in operating activities
Depreciation and amortization	1,541	1,495
Amortization of operating lease assets	1,088	1,008
Stock-based compensation expense	13,560	13,408
Amortization of premium (accretion of discount) on short-term investments	(878)	449
Provision for doubtful accounts	123	(50)
Write-down of inventory	1,253	1,086
Amortization of debt discount and issuance costs	308	298
Unrealized (gains) losses on foreign currency transactions	(166)	252
Changes in operating assets and liabilities
Accounts receivable	13,132	7,015
Inventories	(14,296)	1,919
Prepaid expenses and other current assets	(4,691)	(7,915)
Other assets	61	3
Accounts payable	2,783	(5,190)
Accrued liabilities	(6,752)	(6,673)
Other long-term liabilities	(1,351)	(1,198)
Net cash provided by (used in) operating activities	(29,314)	(28,418)
Cash flows from investing activities
Purchases of short-term investments	(54,560)	(40,226)
Proceeds from maturity of short-term investments	32,500	91,900
Purchases of property and equipment	(2,588)	(1,607)
Net cash provided by investing activities	(24,648)	50,067
Cash flows from financing activities
Minimum tax withholding paid on behalf of employees for net share settlement	(2,273)	(7,298)
Proceeds from issuance of common stock to employees		545
Net cash used in financing activities	(2,273)	(6,753)
Effect of exchange rate changes on cash and cash equivalents	89	(135)
Net increase (decrease) in cash, cash equivalents and restricted cash	(56,146)	14,761
Cash, cash equivalents and restricted cash
Cash, cash equivalents and restricted cash at beginning of period	120,979	35,316
Cash, cash equivalents and restricted cash at end of period	64,833	50,077
Significant non-cash transactions
Purchases of property and equipment in accounts payable	$ 358	$ 585

Summary of Significant Accounti

Summary of Significant Accounting Policies	3 Months Ended
Summary of Significant Accounting Policies	Mar. 31, 2023
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	1. Summary of Significant Accounting Policies Basis of Presentation The accompanying interim condensed consolidated financial statements as of March 31, 2023 and for the three months ended March 31, 2023 and 2022, and the related interim information contained within the notes to the financial statements, are unaudited. The unaudited interim condensed consolidated financial statements (the condensed consolidated financial statements) have been prepared in accordance with generally accepted accounting principles in the United States (U.S. GAAP) for interim financial information and on the same basis as the audited financial statements included on the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (the Annual Report) filed with the Securities and Exchange Commission (SEC) on February 21, 2023. The condensed consolidated financial statements are prepared in U.S. dollars and include the Company’s accounts and those of its wholly-owned subsidiaries. All intercompany accounts and transactions have been eliminated. In the opinion of management, the accompanying unaudited interim condensed consolidated financial statements contain all adjustments (consisting of normal recurring adjustments) necessary to state fairly the Company’s financial position as of March 31, 2023, the results of its operations for the three months ended March 31, 2023 and 2022 and the consolidated statements of cash flows for the three months ended March 31, 2023 and 2022. All such adjustments are of a normal and recurring nature. The interim financial data as of March 31, 2023 is not necessarily indicative of the results to be expected for the year ending December 31, 2023, or for any future period. The consolidated balance sheet as of December 31, 2022 was derived from the audited financials as of that date. The accompanying condensed consolidated financial statements and related financial information should be read in conjunction with the audited consolidated financial statements and the related notes thereto for the year ended December 31, 2022 included in the Annual Report. Use of Estimates The preparation of financial statements in accordance with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Estimates are based on historical experience, where applicable, and other assumptions believed to be reasonable by the management. Actual results may differ from those estimates under different assumptions or conditions. The COVID-19 pandemic has negatively impacted, and may continue to negatively impact the Company’s operations and revenues and overall financial condition. Due to the COVID-19 pandemic, there has been uncertainty and disruption in the global economy and financial markets which could impact the Company’s estimates and assumptions. Changes in the Company’s assessment about the length and severity of the pandemic, as well as other factors, could result in actual results differing from estimates. Foreign Currency Translation Unrealized foreign exchange gains and losses from the remeasurement of assets and liabilities denominated in currencies other than the functional currency of the reporting entity are recorded in other income (expense), net. Additionally, realized gains and losses resulting from transactions denominated in currencies other than the local currency are recorded in other income (expense), net in the condensed consolidated statements of operations and comprehensive loss. The Company recorded net unrealized and net realized foreign currency transaction gains (losses) during the periods presented as follows (in thousands): Three Months Ended March 31, 2023 2022 Net unrealized foreign currency gain (loss) $ 133 $ 166 Net realized foreign currency gain (loss) ( 128 ) ( 75 ) Significant Accounting Policies There have been no material changes to the Company’s significant accounting policies from its Annual Report.

Revenue

Revenue	3 Months Ended
Revenue	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Revenue	2. Revenue The following table presents revenue by geography, based on the billing address of the customer (in thousands): Three Months Ended March 31, 2023 2022 United States $ 82,321 $ 73,214 International 14,006 14,628 Total revenue $ 96,327 $ 87,842 The United States is the only country that accounts for 10% or more of the revenue during the periods presented: Three Months Ended March 31, 2023 2022 United States 85 % 83 % There were no customers that accounted for 10 % or more of the Company’s revenue for each of the three months ended March 31, 2023 and 2022 . Additionally, there were no customers that accounted for 10 % or more of the Company’s accounts receivable balance as of March 31, 2023 and December 31, 2022. For the three months ended March 31, 2023, the Company recognized bad debt expenses of $ 0.1 million. For the three months ended March 31, 2022 , the Company recognized bad debt credits of $ 0.1 million, respectively. In July 2021, the Company received FDA approval of its proprietary 10 kHz Therapy for the management of chronic intractable pain of the lower limbs, including unilateral or bilateral pain, associated with painful diabetic neuropathy (PDN). For the three months ended March 31, 2023 and 2022 , PDN represented 16 % and 7 % of worldwide permanent implant procedures, respectively, which resulted in approximately $ 15.6 million and $ 6.0 million in revenue, respectively. The Company classifies PDN revenue by using estimates and assumptions based on historical experiences and knowledge of current conditions, given available information.

Lease Accounting

Lease Accounting	3 Months Ended
Lease Accounting	Mar. 31, 2023
Leases [Abstract]
Lease Accounting	3. Lease Accounting The Company has operating leases for office space, a manufacturing facility, warehouse, research and development facilities and equipment. Leases with terms of 12 months or less are not recorded on the balance sheet, as the related lease expenses are recognized on a straight-line basis over the lease term. The Company accounts for lease components (such as fixed payments) separately from non-lease components (such as common area expenses). The weighted average lease terms and discounts rates are as follows: March 31, 2023 December 31, 2022 Operating Lease Term and Discount Rate Weighted-average remaining lease term 3.20 years 3.38 years Weighted-average discount rate 7.0 % 7.0 % As of March 31, 2023, the maturity of lease liabilities are as follows (in thousands): Operating Leases 2023, remaining months $ 4,541 2024 6,201 2025 2,849 2026 405 2027 417 Thereafter 1,561 Total lease payments 15,974 Less: Interest ( 1,706 ) Present value of lease liabilities $ 14,268 Supplemental lease cost information are as follows (in thousands): Three Months Ended March 31, 2023 2022 Operating lease cost $ 1,342 $ 1,342 Supplemental balance sheet information are as follows (in thousands): March 31, 2023 December 31, 2022 Operating Leases: Operating lease assets $ 12,341 $ 13,430 Other current liabilities $ 5,323 $ 5,195 Long term operating lease liabilities 8,945 10,296 Total operating lease liabilities $ 14,268 $ 15,491 Supplemental cash flow information are as follows (in thousands): Three Months Ended March 31, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flow from operating leases $ 1,478 $ 1,375 See Note 6 for further details of the Company’s lease commitments.

Fair Value Measurements

Fair Value Measurements	3 Months Ended
Fair Value Measurements	Mar. 31, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	4. Fair Value Measurements Cash Equivalents and Short-Term Investments The Company’s money market funds are classified within Level 1 of the fair value hierarchy and are valued based on quoted prices in active markets for identical securities. The Company’s short-term investments are comprised of agency bonds, commercial paper, corporate notes and treasury bonds. All short-term investments have been classified within Level 1 or Level 2 of the fair value hierarchy because of the sufficient observable inputs for revaluation. The Company’s Level 2 investments are valued using third-party pricing sources. The pricing services utilize industry-standard valuation models, including both income and market-based approaches, for which all significant inputs are observable, either directly or indirectly, to estimate fair value. These inputs include reported trades of and broker/dealer quotes on the same or similar investments, issuer credit spreads, benchmark investments, prepayment/default projections based on historical data and other observable inputs. The following table sets forth the Company’s financial instruments that were measured at fair value on a recurring basis by level within the fair value hierarchy (in thousands): Balance as of March 31, 2023 Level 1 Level 2 Level 3 Total Assets: Money market funds (i) $ 34,219 $ — $ — $ 34,219 Agency bonds (ii) — 220,446 — 220,446 Commercial paper (iii) — 40,975 — 40,975 Treasury bonds (ii) 30,933 — — 30,933 Total assets $ 65,152 $ 261,421 $ — $ 326,573 Balance as of December 31, 2022 Level 1 Level 2 Level 3 Total Assets: Money market funds (i) $ 92,318 $ — $ — $ 92,318 Agency bonds (ii) — 183,678 — 183,678 Commercial paper (ii) — 24,742 — 24,742 Treasury bonds (ii) 45,592 — — 45,592 Total assets $ 137,910 $ 208,420 $ — $ 346,330 (i) Included in cash and cash equivalents on the condensed consolidated balance sheets. (ii) Included in short-term investments on the condensed consolidated balance sheets. (iii) Included in cash and cash equivalents or short-term investments on the condensed consolidated balance sheets. Convertible Senior Notes As of March 31, 2023 and December 31, 2022 , the fair value of the 2.75 % convertible senior notes due 2025 was $ 177.3 million and $ 174.2 million, respectively. The fair value was determined on the basis of market prices observable for similar instruments and is considered Level 2 in the fair value hierarchy (See Note 7).

Balance Sheet Components

Balance Sheet Components	3 Months Ended
Balance Sheet Components	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Balance Sheet Components	5. Balance Sheet Components Cash and Cash Equivalents The Company considers all highly-liquid investments purchased with an original maturity of three months or less at the date of purchase to be cash equivalents. Cash and cash equivalents include money market funds in the amount of $ 34.2 million and $ 92.3 million as of March 31, 2023 and December 31, 2022, respectively. As of March 31, 2023 and December 31, 2022, the Company’s cash equivalents were held at institutions in the United States and include deposits in a money market fund which was unrestricted as to withdrawal or use. The Company also held cash in foreign banks of approximately $ 8.0 million at March 31, 2023 and $ 18.6 million at December 31, 2022 that was not insured. The Company has not experienced any losses on its deposits of cash and cash equivalents. Investments The Company measures its cash equivalents and short-term investments at fair value, with unrealized gains and losses recorded in accumulated other comprehensive income within stockholders’ equity. The Company regularly reviews its investments and evaluates the current expected credit loss by considering factors such as historical experience, market data, and the near-term prospects of the investee. The following is a summary of the gross unrealized gains and unrealized losses on the Company’s investment securities, excluding investments in money market funds (in thousands): March 31, 2023 Amortized Gross Gross Aggregate Investment Securities Agency bonds $ 221,163 $ 3 $ ( 720 ) $ 220,446 Commercial paper 40,994 2 ( 21 ) 40,975 Treasury bonds 31,038 12 ( 117 ) 30,933 Total securities $ 293,195 $ 17 $ ( 858 ) $ 292,354 December 31, 2022 Amortized Gross Gross Aggregate Investment Securities Agency bonds $ 184,666 $ 2 $ ( 990 ) $ 183,678 Commercial paper 24,767 5 ( 30 ) 24,742 Treasury bonds 46,008 — ( 416 ) 45,592 Total securities $ 255,441 $ 7 $ ( 1,436 ) $ 254,012 Realized gains or losses and other-than-temporary impairments, if any, on available-for-sale securities are reported in other income (expense), net as incurred. The cost of securities sold is determined based on the specific identification method. The amount of realized gains and realized losses on investments recorded for the periods presented has not been material. The contractual maturities of the Company’s investment securities as of March 31, 2023 were as follows (in thousands): Amortized Cost Fair Value Amounts maturing within one year $ 283,671 $ 282,818 Amounts maturing after one year through five years 9,524 9,536 Total investment securities $ 293,195 $ 292,354 Inventories (in thousands) March 31, December 31, 2023 2022 Raw materials $ 57,477 $ 53,384 Work in process 2,551 1,195 Finished goods 53,265 45,059 Total inventories $ 113,293 $ 99,638 Inventories are stated at the lower of cost or net realizable value. Cost is determined using the standard cost method which approximates the first-in, first-out basis. Net realizable value is determined as the prices in the ordinary course of business, less reasonably predictable costs of completion, disposal and transportation. The Company regularly reviews inventory quantities compared to forecasted sales to record a provision for excess and obsolete inventory when appropriate. Inventory write-downs are recorded for excess and obsolete inventory. The Company estimates forecasted sales by considering product acceptance in the marketplace, customer demand, historical sales, product obsolescence and technological innovations. The Company periodically evaluates the carrying value of inventory on hand for potential excess amount over demand using the same lower of cost or net realizable value approach as that has been used to value the inventory. The Company also periodically evaluates inventory quantities in consideration of actual loss experience. As a result of these evaluations, the Company recognized total write-downs of $ 1.3 million and $ 1.1 million, respectively, for its inventories for the three months ended March 31, 2023 and 2022 . Property and Equipment, Net (in thousands) March 31, December 31, 2023 2022 Laboratory and manufacturing equipment $ 11,940 $ 11,482 Computer equipment and software 21,530 18,626 Furniture and fixtures 4,485 4,421 Leasehold improvements 10,589 10,589 Construction in process 4,739 5,984 Total 53,283 51,102 Less: Accumulated depreciation and amortization ( 30,372 ) ( 28,831 ) Property and equipment, net $ 22,911 $ 22,271 The Company recognized depreciation and amortization expense on property and equipment as follows (in thousands): Three Months Ended March 31, 2023 2022 Depreciation and amortization expense $ 1,541 $ 1,495 Accrued Liabilities (in thousands) March 31, December 31, 2023 2022 Accrued payroll and related expenses $ 26,490 $ 35,341 Accrued professional fees 2,877 1,425 Accrued taxes 2,974 1,910 Accrued clinical and research expenses 235 282 Accrued interest 2,609 1,305 Accrued warranty 1,147 866 Accrued other 4,035 6,039 Total accrued liabilities $ 40,367 $ 47,168

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
Commitments and Contingencies	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	6. Commitments and Contingencies Operating Leases In March 2015 , the Company entered into a lease agreement for approximately 50,000 square feet of office space located in Redwood City, California for a period beginning on June 30, 2015 and ending in May 2022 , with initial annual payments of approximately $ 2.0 million, increasing to $ 2.4 million annually during the final year of the lease term. In December 2016, the Company entered into a first amendment to the lease for an additional approximately 50,000 square feet of office space adjacent to the premises under the original lease (the Expansion Premises), with initial annual payments of $ 1.2 million, increasing to $ 2.9 million in the final year of the amended lease term. The lease for the Expansion Premises commenced on June 1, 2018 , and it will expire on May 31, 2025 . The first amendment also extends the lease term for the original premises to terminate on the same date as the Expansion Premises. The Company entered into a separate non-cancellable facility lease for warehouse space beginning on March 1, 2017 through February 28, 2022 , under which it is obligated to pay approximately $ 0.4 million in lease payments over the term of the lease. In October 2021, the Company entered into a first amendment of the warehouse lease, which extends the lease term to terminate on May 31, 2025 and under which the Company is obligated to pay approximately $ 0.4 million over the term of the extension period. In August 2020 , the Company entered into a lease for approximately 35,411 square feet of space for a manufacturing facility in Costa Rica to begin in April 2021 and to last through June 2031 , under which it is obligated to pay approximately $ 3.9 million in lease payments over the term of the lease. On the commencement date in April 2021, the Company classified and measured the lease, resulting in the recording of operating assets of $ 2.9 million and operating lease liabilities of $ 2.9 million. See Note 3 for further discussion on Lease Accounting. Warranty Obligations The Company provides a limited one- to five-year warranty and warrants that its products will operate substantially in conformity with product specifications. The Company records an estimate for the provision for warranty claims in cost of revenue when the related revenues are recognized. This estimate is based on historical and anticipated rates of warranty claims, the cost per claim and the number of units sold. The Company regularly assesses the adequacy of its recorded warranty obligations and adjusts the amounts as necessary. Activities related to warranty obligations were as follows (in thousands): Three Months Ended March 31, 2023 2022 Beginning balance $ 866 $ 664 Provision for warranty 1,763 715 Utilization ( 1,482 ) ( 927 ) Ending balance $ 1,147 $ 452 Contingencies From time to time, the Company may have certain contingent liabilities that arise in the ordinary course of business activities related to, for example, employment matters and patent issues. The Company accrues a liability for such matters when it is probable that future expenditures will be made and such expenditures can be reasonably estimated. When determining the estimated loss or range of loss, significant judgement is required. Indemnification The Company enters into standard indemnification arrangements in the ordinary course of business. Pursuant to these arrangements, the Company indemnifies, holds harmless and agrees to reimburse the indemnified parties for losses suffered or incurred by the indemnified party, in connection with any trade secret, copyright, patent or other intellectual property infringement claim by any third-party with respect to the Company’s technology. The term of these indemnification agreements is generally perpetual. The maximum potential amount of future payments the Company could be required to make under these agreements is not determinable because it involves claims that may be made against the Company in the future, but have not yet been made. The Company has entered into indemnification agreements with its directors and officers that may require the Company to indemnify its directors and officers against liabilities that may arise by reason of their status or service as directors or officers, other than liabilities arising from willful misconduct of the individual. The maximum potential amount of future payments the Company could be required to make under these indemnification agreements is unlimited; however, the Company has director and officer insurance coverage that reduces the Company’s exposure and enables the Company to recover a portion of any future amounts paid. The Company believes the estimated fair value of these indemnification agreements in excess of applicable insurance coverage is minimal. Legal Matters The Company is and may from time to time continue to be involved in various legal proceedings to defend its intellectual property, including several pending European patent oppositions at the European Patent Office (EPO) initiated by the Company’s competitors Medtronic and Boston Scientific. In addition, the Company is and may from time to time also be involved in various legal proceedings of a character normally incident to the ordinary course of business, such as employment matters, product liability matters, and professional liability matters, which the Company does not deem to be material to its business and condensed consolidated financial statements at this stage. Flathead Partners Litigation/Arbitration On July 15, 2022, the Company filed a lawsuit in the U.S. District Court for the Northern District of California for breach of contract against Flathead Partners, LLC, the Mayo Foundation for Medical Education and Research, and Mayo Clinic Ventures (herein referred to as “Flathead Partners”). The Company’s suit alleged that Flathead Partners breached the 2006 license agreement between the Company and the Mayo Clinic (referred to in the Company’s 10-K filing as the “Mayo License”), when Flathead Partners unilaterally asserted control of pending U.S. Patent Application 16/286,389 (the “’389 Application”), which is subject to the Mayo License. The suit sought to enjoin the Flathead Partners from taking any action at the U.S. Patent Office with respect to the ‘389 Application, and to thereafter engage in an arbitration as called for in the Mayo License. On July 27, 2022, the Flathead Partners agreed to enter into an arbitration to determine which party shall have control of prosecution of the ‘389 Application, and whether there are ongoing royalty obligations under the Mayo License. Therefore, Nevro dismissed the lawsuit in the Northern District of California. The parties have since been engaged in an arbitration. Civil Investigative Demand In December 2022, the Company received a civil investigative demand (CID) pursuant to the federal False Claims Act from the United States Attorney’s Office for the Northern District of California seeking information relating to the Company’s spinal cord stimulation system (SCS System). The CID primarily relates to marketing, promotion and billing practices, not the therapeutic or safety attributes of the Company’s SCS System. The Company maintains rigorous policies and procedures designed to promote compliance with the federal False Claims Act and other regulatory requirements, and is cooperating in this matter and providing the requested information.

Debt

Debt	3 Months Ended
Debt	Mar. 31, 2023
Debt Disclosure [Abstract]
Debt	7. Debt 2025 Notes and Convertible Note Hedge and Warrant Transactions During the three months ended March 31, 2023, the conditions allowing holders of the 2025 Notes to convert have not been met. Therefore, the 2025 Notes are not convertible during the three months ended June 30, 2023. As of March 31, 2023 , the if-converted value of the 2025 Notes did no t exceed the principal value of those notes. The net carrying amount of the liability component of the 2025 Notes was as follows (in thousands): March 31, December 31, 2023 2022 Principal $ 189,750 $ 189,750 Unamortized issuance cost ( 2,575 ) ( 2,883 ) Net carrying amount $ 187,175 $ 186,867 The following table sets forth the interest expense recognized related to the 2025 Notes (in thousands): Three Months Ended March 31, 2023 2022 Contractual interest expense $ 1,305 $ 1,305 Amortization of debt issuance costs 308 298 Total interest expense $ 1,613 $ 1,603

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
Stock-Based Compensation	Mar. 31, 2023
Equity [Abstract]
Stock-Based Compensation	8. Stock-Based Compensation The Company accounts for stock-based compensation arrangements with employees in accordance with Accounting Standards Codification (ASC) 718, Compensation—Stock Compensation. ASC 718 requires the recognition of compensation expense, using a fair value-based method, for costs related to all share-based payments including stock options. The Company estimates forfeitures expected to occur to determine the amount of compensation cost recognized in each period. In addition to restricted stock units, the Company grants performance stock units (PSUs) to certain members of the management team. For the three months ended March 31, 2023, the Company granted 175,088 shares of PSUs with a weighted average fair value of $ 38.90 . For the three months ended March 31, 2022, the Company granted 392,742 shares of PSUs with a weighted average fair value of $ 54.00 . These PSUs vest over a three-year period, subject to continued service, and are based on (1) the total shareholder return (TSR) of the Company’s common stock price compared to the S&P Healthcare Equipment Select Industry Index (the Index) over a two-year period or (2) specific revenue targets over a two-year performance period. Additionally, the grants from 2022 included PSUs that vest over a three-year period and are based on the attainment of specified stock prices. Since TSR and stock price attainment are considered market conditions, the PSUs based on TSR and stock price attainment have fair values that are determined at the grant date using the Monte Carlo simulation model, with the recorded expense based on fair value. Since revenue targets are considered performance conditions, the PSUs based on revenue targets have a fair value that is equal to the closing stock price on the grant date, with the recorded expense based on the fair value and the probability of achievement, which is reassessed at each reporting period. A summary of stock-based compensation expense by line items in the consolidated statements of operations is as follows (in thousands): Three Months Ended March 31, 2023 2022 Cost of revenue 442 554 Research and development 2,644 2,051 Sales, general and administrative 10,474 10,803 Total stock-based compensation expense 13,560 13,408 A summary of pre-tax stock-based compensation expense by category was as follows (in thousands): Three Months Ended March 31, 2023 2022 Stock Options 295 572 Restricted stock units 9,555 8,777 Performance stock units 2,832 3,314 Employee stock purchase plan 878 745 Total stock-based compensation expense 13,560 13,408

Basic and Diluted Net Income (L

Basic and Diluted Net Income (Loss) Per Share	3 Months Ended
Basic and Diluted Net Income (Loss) Per Share	Mar. 31, 2023
Earnings Per Share [Abstract]
Basic and Diluted Net Income (Loss) Per Share	9. Basic and Diluted Net Income (Loss) Per Share Basic net loss per share is computed by dividing the net loss by the weighted average number of common shares outstanding for the period. Diluted net income (loss) per share is computed by dividing the net income (loss) by the weighted average number of common shares and dilutive common stock equivalents outstanding for the period, if inclusion of these is dilutive. The Company uses the if-converted method and presumes share settlement for its 2025 Notes when calculating the dilutive effect of these notes. In connection with the offerings of the convertible senior notes, the Company entered into convertible note hedges and warrants. However, the convertible note hedges are not included when calculating potentially dilutive shares since their effect is always anti-dilutive. Warrants were considered anti-dilutive to the extent that their strike price were above the Company's average share price during the period. Because the Company has reported a net loss for the three months ended March 31, 2023 and 2022, the diluted net loss per common share is the same as basic net loss per common share for those periods. The following potentially dilutive securities outstanding at the end of the periods presented have been excluded from the computation of diluted shares outstanding, as the effect would be anti-dilutive: The following table summarizes the computation of basic and diluted net loss per share (in thousands, except share and per share data): Three Months Ended March 31, 2023 2022 Net loss, basic and diluted $ ( 35,029 ) $ ( 34,325 ) Weighted average shares used to compute 35,584,685 35,073,862 Net loss per share, basic and diluted $ ( 0.98 ) $ ( 0.98 ) The following potentially dilutive securities outstanding at the end of the periods presented have been excluded from the computation of diluted shares outstanding, as the effect would be anti-dilutive: March 31, 2023 2022 Unreleased restricted stock 2,403,168 1,691,713 Options to purchase common stock 606,785 688,762 Convertible senior notes 1,807,141 1,807,141 Warrants related to the issuance of convertible senior notes 1,807,141 1,807,141 Total 6,624,235 5,994,757

Employee Benefit Plans

Employee Benefit Plans	3 Months Ended
Employee Benefit Plans	Mar. 31, 2023
Postemployment Benefits [Abstract]
Employee Benefit Plans	10. Employee Benefit Plans 401(k) Plan In 2007, the Company adopted a 401(k) plan for its employees whereby eligible employees may contribute up to the maximum amount permitted by the Internal Revenue Code. In June 2016, the Company adopted a policy to match a portion of employee contributions for all qualified employees participating in the 401(k) plan. The Company recorded an expense for matching contributions of $ 2.4 million and $ 2.3 million for the three months ended March 31, 2023 and 2022 , respectively.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	3 Months Ended
Summary of Significant Accounting Policies (Policies)	Mar. 31, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying interim condensed consolidated financial statements as of March 31, 2023 and for the three months ended March 31, 2023 and 2022, and the related interim information contained within the notes to the financial statements, are unaudited. The unaudited interim condensed consolidated financial statements (the condensed consolidated financial statements) have been prepared in accordance with generally accepted accounting principles in the United States (U.S. GAAP) for interim financial information and on the same basis as the audited financial statements included on the Company’s Annual Report on Form 10-K for the year ended December 31, 2022 (the Annual Report) filed with the Securities and Exchange Commission (SEC) on February 21, 2023. The condensed consolidated financial statements are prepared in U.S. dollars and include the Company’s accounts and those of its wholly-owned subsidiaries. All intercompany accounts and transactions have been eliminated. In the opinion of management, the accompanying unaudited interim condensed consolidated financial statements contain all adjustments (consisting of normal recurring adjustments) necessary to state fairly the Company’s financial position as of March 31, 2023, the results of its operations for the three months ended March 31, 2023 and 2022 and the consolidated statements of cash flows for the three months ended March 31, 2023 and 2022. All such adjustments are of a normal and recurring nature. The interim financial data as of March 31, 2023 is not necessarily indicative of the results to be expected for the year ending December 31, 2023, or for any future period. The consolidated balance sheet as of December 31, 2022 was derived from the audited financials as of that date. The accompanying condensed consolidated financial statements and related financial information should be read in conjunction with the audited consolidated financial statements and the related notes thereto for the year ended December 31, 2022 included in the Annual Report.
Use of Estimates	Use of Estimates The preparation of financial statements in accordance with U.S. GAAP requires management to make estimates and assumptions that affect the amounts reported in the condensed consolidated financial statements and accompanying notes. Estimates are based on historical experience, where applicable, and other assumptions believed to be reasonable by the management. Actual results may differ from those estimates under different assumptions or conditions. The COVID-19 pandemic has negatively impacted, and may continue to negatively impact the Company’s operations and revenues and overall financial condition. Due to the COVID-19 pandemic, there has been uncertainty and disruption in the global economy and financial markets which could impact the Company’s estimates and assumptions. Changes in the Company’s assessment about the length and severity of the pandemic, as well as other factors, could result in actual results differing from estimates.
Foreign Currency Translation	Foreign Currency Translation Unrealized foreign exchange gains and losses from the remeasurement of assets and liabilities denominated in currencies other than the functional currency of the reporting entity are recorded in other income (expense), net. Additionally, realized gains and losses resulting from transactions denominated in currencies other than the local currency are recorded in other income (expense), net in the condensed consolidated statements of operations and comprehensive loss. The Company recorded net unrealized and net realized foreign currency transaction gains (losses) during the periods presented as follows (in thousands): Three Months Ended March 31, 2023 2022 Net unrealized foreign currency gain (loss) $ 133 $ 166 Net realized foreign currency gain (loss) ( 128 ) ( 75 )
Significant Accounting Policies	Significant Accounting Policies There have been no material changes to the Company’s significant accounting policies from its Annual Report.
Cash and Cash Equivalents	Cash and Cash Equivalents The Company considers all highly-liquid investments purchased with an original maturity of three months or less at the date of purchase to be cash equivalents. Cash and cash equivalents include money market funds in the amount of $ 34.2 million and $ 92.3 million as of March 31, 2023 and December 31, 2022, respectively. As of March 31, 2023 and December 31, 2022, the Company’s cash equivalents were held at institutions in the United States and include deposits in a money market fund which was unrestricted as to withdrawal or use. The Company also held cash in foreign banks of approximately $ 8.0 million at March 31, 2023 and $ 18.6 million at December 31, 2022 that was not insured. The Company has not experienced any losses on its deposits of cash and cash equivalents.
Inventories	Inventories Inventories are stated at the lower of cost or net realizable value. Cost is determined using the standard cost method which approximates the first-in, first-out basis. Net realizable value is determined as the prices in the ordinary course of business, less reasonably predictable costs of completion, disposal and transportation. The Company regularly reviews inventory quantities compared to forecasted sales to record a provision for excess and obsolete inventory when appropriate. Inventory write-downs are recorded for excess and obsolete inventory. The Company estimates forecasted sales by considering product acceptance in the marketplace, customer demand, historical sales, product obsolescence and technological innovations. The Company periodically evaluates the carrying value of inventory on hand for potential excess amount over demand using the same lower of cost or net realizable value approach as that has been used to value the inventory. The Company also periodically evaluates inventory quantities in consideration of actual loss experience. As a result of these evaluations, the Company recognized total write-downs of $ 1.3 million and $ 1.1 million, respectively, for its inventories for the three months ended March 31, 2023 and 2022 .

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	3 Months Ended
Summary of Significant Accounting Policies (Tables)	Mar. 31, 2023
Accounting Policies [Abstract]
Net Unrealized and Net Realized Foreign Currency Transaction Gains (Losses)	The Company recorded net unrealized and net realized foreign currency transaction gains (losses) during the periods presented as follows (in thousands): Three Months Ended March 31, 2023 2022 Net unrealized foreign currency gain (loss) $ 133 $ 166 Net realized foreign currency gain (loss) ( 128 ) ( 75 )

Revenue (Tables)

Revenue (Tables)	3 Months Ended
Revenue (Tables)	Mar. 31, 2023
Revenue from Contract with Customer [Abstract]
Summary of Revenue by Geography on Billing Address of Customer	The following table presents revenue by geography, based on the billing address of the customer (in thousands): Three Months Ended March 31, 2023 2022 United States $ 82,321 $ 73,214 International 14,006 14,628 Total revenue $ 96,327 $ 87,842
Schedule of Revenue by Major Customers by Geographic Area	The United States is the only country that accounts for 10% or more of the revenue during the periods presented: Three Months Ended March 31, 2023 2022 United States 85 % 83 %

Lease Accounting (Tables)

Lease Accounting (Tables)	3 Months Ended
Lease Accounting (Tables)	Mar. 31, 2023
Leases [Abstract]
Schedule of Weighted Average Lease Terms and Discounts Rates	The weighted average lease terms and discounts rates are as follows: March 31, 2023 December 31, 2022 Operating Lease Term and Discount Rate Weighted-average remaining lease term 3.20 years 3.38 years Weighted-average discount rate 7.0 % 7.0 %
Schedule of Maturity of Lease Liabilities	As of March 31, 2023, the maturity of lease liabilities are as follows (in thousands): Operating Leases 2023, remaining months $ 4,541 2024 6,201 2025 2,849 2026 405 2027 417 Thereafter 1,561 Total lease payments 15,974 Less: Interest ( 1,706 ) Present value of lease liabilities $ 14,268
Supplemental Lease Cost Information	Supplemental lease cost information are as follows (in thousands): Three Months Ended March 31, 2023 2022 Operating lease cost $ 1,342 $ 1,342
Schedule Of Operating Lease Assets and Liabilities	Supplemental balance sheet information are as follows (in thousands): March 31, 2023 December 31, 2022 Operating Leases: Operating lease assets $ 12,341 $ 13,430 Other current liabilities $ 5,323 $ 5,195 Long term operating lease liabilities 8,945 10,296 Total operating lease liabilities $ 14,268 $ 15,491
Schedule of Supplemental Cash Flow Information Related to Lease	Supplemental cash flow information are as follows (in thousands): Three Months Ended March 31, 2023 2022 Cash paid for amounts included in the measurement of lease liabilities: Operating cash flow from operating leases $ 1,478 $ 1,375

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	3 Months Ended
Fair Value Measurements (Tables)	Mar. 31, 2023
Fair Value Disclosures [Abstract]
Financial Instruments Measured at Fair Value on Recurring Basis	The following table sets forth the Company’s financial instruments that were measured at fair value on a recurring basis by level within the fair value hierarchy (in thousands): Balance as of March 31, 2023 Level 1 Level 2 Level 3 Total Assets: Money market funds (i) $ 34,219 $ — $ — $ 34,219 Agency bonds (ii) — 220,446 — 220,446 Commercial paper (iii) — 40,975 — 40,975 Treasury bonds (ii) 30,933 — — 30,933 Total assets $ 65,152 $ 261,421 $ — $ 326,573 Balance as of December 31, 2022 Level 1 Level 2 Level 3 Total Assets: Money market funds (i) $ 92,318 $ — $ — $ 92,318 Agency bonds (ii) — 183,678 — 183,678 Commercial paper (ii) — 24,742 — 24,742 Treasury bonds (ii) 45,592 — — 45,592 Total assets $ 137,910 $ 208,420 $ — $ 346,330 (i) Included in cash and cash equivalents on the condensed consolidated balance sheets. (ii) Included in short-term investments on the condensed consolidated balance sheets. (iii) Included in cash and cash equivalents or short-term investments on the condensed consolidated balance sheets.

Balance Sheet Components (Table

Balance Sheet Components (Tables)	3 Months Ended
Balance Sheet Components (Tables)	Mar. 31, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Summary of Gross Unrealized Gains and Unrealized Losses of Investment Securities Excluding Investments in Money Market Funds	The following is a summary of the gross unrealized gains and unrealized losses on the Company’s investment securities, excluding investments in money market funds (in thousands): March 31, 2023 Amortized Gross Gross Aggregate Investment Securities Agency bonds $ 221,163 $ 3 $ ( 720 ) $ 220,446 Commercial paper 40,994 2 ( 21 ) 40,975 Treasury bonds 31,038 12 ( 117 ) 30,933 Total securities $ 293,195 $ 17 $ ( 858 ) $ 292,354 December 31, 2022 Amortized Gross Gross Aggregate Investment Securities Agency bonds $ 184,666 $ 2 $ ( 990 ) $ 183,678 Commercial paper 24,767 5 ( 30 ) 24,742 Treasury bonds 46,008 — ( 416 ) 45,592 Total securities $ 255,441 $ 7 $ ( 1,436 ) $ 254,012
Summary of Contractual Maturities of Investment Securities	The contractual maturities of the Company’s investment securities as of March 31, 2023 were as follows (in thousands): Amortized Cost Fair Value Amounts maturing within one year $ 283,671 $ 282,818 Amounts maturing after one year through five years 9,524 9,536 Total investment securities $ 293,195 $ 292,354
Components of Inventories	Inventories (in thousands) March 31, December 31, 2023 2022 Raw materials $ 57,477 $ 53,384 Work in process 2,551 1,195 Finished goods 53,265 45,059 Total inventories $ 113,293 $ 99,638
Schedule of Property and Equipment, Net and Depreciation and Amortization Expense	Property and Equipment, Net (in thousands) March 31, December 31, 2023 2022 Laboratory and manufacturing equipment $ 11,940 $ 11,482 Computer equipment and software 21,530 18,626 Furniture and fixtures 4,485 4,421 Leasehold improvements 10,589 10,589 Construction in process 4,739 5,984 Total 53,283 51,102 Less: Accumulated depreciation and amortization ( 30,372 ) ( 28,831 ) Property and equipment, net $ 22,911 $ 22,271 The Company recognized depreciation and amortization expense on property and equipment as follows (in thousands): Three Months Ended March 31, 2023 2022 Depreciation and amortization expense $ 1,541 $ 1,495
Summary of Accrued Liabilities	Accrued Liabilities (in thousands) March 31, December 31, 2023 2022 Accrued payroll and related expenses $ 26,490 $ 35,341 Accrued professional fees 2,877 1,425 Accrued taxes 2,974 1,910 Accrued clinical and research expenses 235 282 Accrued interest 2,609 1,305 Accrued warranty 1,147 866 Accrued other 4,035 6,039 Total accrued liabilities $ 40,367 $ 47,168

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
Commitments and Contingencies (Tables)	Mar. 31, 2023
Commitments and Contingencies Disclosure [Abstract]
Schedule of Activities Related to Warranty Obligations	Activities related to warranty obligations were as follows (in thousands): Three Months Ended March 31, 2023 2022 Beginning balance $ 866 $ 664 Provision for warranty 1,763 715 Utilization ( 1,482 ) ( 927 ) Ending balance $ 1,147 $ 452

Debt (Tables)

Debt (Tables) - 2025 Notes and Convertible Notes [Member]	3 Months Ended
Debt (Tables) - 2025 Notes and Convertible Notes [Member]	Mar. 31, 2023
Debt Instrument [Line Items]
Interest Expense Recognized Related to Convertible Notes	The following table sets forth the interest expense recognized related to the 2025 Notes (in thousands): Three Months Ended March 31, 2023 2022 Contractual interest expense $ 1,305 $ 1,305 Amortization of debt issuance costs 308 298 Total interest expense $ 1,613 $ 1,603
Debt, Liability Component [Member]
Debt Instrument [Line Items]
Net Carrying Amount of Convertible Debt	The net carrying amount of the liability component of the 2025 Notes was as follows (in thousands): March 31, December 31, 2023 2022 Principal $ 189,750 $ 189,750 Unamortized issuance cost ( 2,575 ) ( 2,883 ) Net carrying amount $ 187,175 $ 186,867

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
Stock-Based Compensation (Tables)	Mar. 31, 2023
Equity [Abstract]
Summary of Stock-Based Compensation Expense by Line Items in Consolidated Statements of Operations	A summary of stock-based compensation expense by line items in the consolidated statements of operations is as follows (in thousands): Three Months Ended March 31, 2023 2022 Cost of revenue 442 554 Research and development 2,644 2,051 Sales, general and administrative 10,474 10,803 Total stock-based compensation expense 13,560 13,408
Summary of Stock-Based Compensation Expense	A summary of pre-tax stock-based compensation expense by category was as follows (in thousands): Three Months Ended March 31, 2023 2022 Stock Options 295 572 Restricted stock units 9,555 8,777 Performance stock units 2,832 3,314 Employee stock purchase plan 878 745 Total stock-based compensation expense 13,560 13,408

Basic and Diluted Net Income _2

Basic and Diluted Net Income (Loss) Per Share (Tables)	3 Months Ended
Basic and Diluted Net Income (Loss) Per Share (Tables)	Mar. 31, 2023
Earnings Per Share [Abstract]
Computation of Basic and Diluted Net Loss per Share	The following table summarizes the computation of basic and diluted net loss per share (in thousands, except share and per share data): Three Months Ended March 31, 2023 2022 Net loss, basic and diluted $ ( 35,029 ) $ ( 34,325 ) Weighted average shares used to compute 35,584,685 35,073,862 Net loss per share, basic and diluted $ ( 0.98 ) $ ( 0.98 )
Computation of Potentially Dilutive Securities Outstanding Excluded from Computation of Diluted Shares	The following potentially dilutive securities outstanding at the end of the periods presented have been excluded from the computation of diluted shares outstanding, as the effect would be anti-dilutive: March 31, 2023 2022 Unreleased restricted stock 2,403,168 1,691,713 Options to purchase common stock 606,785 688,762 Convertible senior notes 1,807,141 1,807,141 Warrants related to the issuance of convertible senior notes 1,807,141 1,807,141 Total 6,624,235 5,994,757

Summary of Significant Accoun_4

Summary of Significant Accounting Policies - Net Unrealized and Net Realized Foreign Currency Transaction Gains (Losses) (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Accounting Policies [Abstract]
Net unrealized foreign currency gain (loss)	$ (133)	$ 166
Net realized foreign currency gain (loss)	$ 128	$ (75)

Revenue - Summary of Revenue by

Revenue - Summary of Revenue by Geography on Billing Address of Customer (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Disaggregation Of Revenue [Line Items]
Total revenue	$ 96,327	$ 87,842
United States [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	82,321	73,214
International [Member]
Disaggregation Of Revenue [Line Items]
Total revenue	$ 14,006	$ 14,628

Revenue - Schedule of Revenue b

Revenue - Schedule of Revenue by Major Customers by Geographic Area (Detail)	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Revenue Benchmark \| Geographic Concentration Risk [Member] \| United States [Member]
Concentration Risk [Line Items]
Revenue	85%	83%

Revenue - Additional Informatio

Revenue - Additional Information (Detail) $ in Thousands	3 Months Ended
Revenue - Additional Information (Detail) $ in Thousands	Mar. 31, 2023 USD ($) Customer	Mar. 31, 2022 USD ($) Customer
Disaggregation Of Revenue [Line Items]
Bad debt expense	$ 100
Bad debt credits		$ 100
Revenue	96,327	87,842
Painful Diabetic Neuropathy [Member]
Disaggregation Of Revenue [Line Items]
Revenue	$ 15,600	$ 6,000
Percentage of permanent implant procedures	16%	7%
Customer Concentration Risk [Member] \| Revenue Benchmark \| Major Customers [Member]
Disaggregation Of Revenue [Line Items]
Concentration risk, percentage	10%	10%
Number of customers accounted 10% or more concentration risk \| Customer	0	0
Credit Concentration Risk [Member] \| Accounts Receivable [Member] \| Major Customers [Member]
Disaggregation Of Revenue [Line Items]
Concentration risk, percentage	10%	10%
Number of customers accounted 10% or more concentration risk \| Customer	0	0

Lease Accounting - Schedule of

Lease Accounting - Schedule of Weighted Average Lease Terms and Discounts Rates (Detail)	Mar. 31, 2023	Dec. 31, 2022
Leases [Abstract]
Weighted-average remaining lease term	3 years 2 months 12 days	3 years 4 months 17 days
Weighted-average discount rate	7%	7%

Lease Accounting - Schedule o_2

Lease Accounting - Schedule of Maturity of Lease Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Leases [Abstract]
2023, remaining months	$ 4,541
2024	6,201
2025	2,849
2026	405
2027	417
Thereafter	1,561
Total lease payments	15,974
Less: Interest	(1,706)
Present value of lease liabilities	$ 14,268	$ 15,491

Lease Accounting - Supplemental

Lease Accounting - Supplemental Lease Cost Information (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Leases [Abstract]
Operating lease cost	$ 1,342	$ 1,342

Lease Accounting - Summary of O

Lease Accounting - Summary of Operating Lease Assets and Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Operating Leases:
Operating lease assets	$ 12,341	$ 13,430
Other current liabilities	$ 5,323	$ 5,195
Operating Lease, Liability, Current, Statement of Financial Position [Extensible Enumeration]	Other current liabilities	Other current liabilities
Long term operating lease liabilities	$ 8,945	$ 10,296
Total operating lease liabilities	$ 14,268	$ 15,491

Lease Accounting - Schedule o_3

Lease Accounting - Schedule of Supplemental Cash Flow Information Related to Lease (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flow from operating leases	$ 1,478	$ 1,375

Fair Value Measurements - Finan

Fair Value Measurements - Financial Instruments Measured at Fair Value on Recurring Basis (Detail) - Fair Value Measurements Recurring [Member] - USD ($) $ in Thousands		Mar. 31, 2023		Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets		$ 326,573		$ 346,330
Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets		65,152		137,910
Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets		261,421		208,420
Money Market Funds [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[1]	34,219		92,318
Money Market Funds [Member] \| Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[1]	34,219		92,318
Agency Bonds [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[2]	220,446		183,678
Agency Bonds [Member] \| Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[2]	220,446		183,678
Commercial Paper [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets		40,975	[3]	24,742	[2]
Commercial Paper [Member] \| Level 2 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets		40,975	[3]	24,742	[2]
Treasury Bonds [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[2]	30,933		45,592
Treasury Bonds [Member] \| Level 1 [Member]
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Total assets	[2]	$ 30,933		$ 45,592

[1] Included in cash and cash equivalents on the condensed consolidated balance sheets. Included in short-term investments on the condensed consolidated balance sheets. Included in cash and cash equivalents or short-term investments on the condensed consolidated balance sheets.

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Detail) - 2.75% Convertible Senior Notes due 2025 [Member] - USD ($) $ in Millions	3 Months Ended	12 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Debt instrument, interest rate	2.75%	2.75%
Debt instrument due year	2025	2025
Fair Value of Notes	$ 177.3	$ 174.2

Balance Sheet Components - Addi

Balance Sheet Components - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Money market funds	$ 34.2		$ 92.3
Cash held in foreign banks	8		$ 18.6
Write down of inventory	$ 1.3	$ 1.1

Balance Sheet Components - Summ

Balance Sheet Components - Summary of Gross Unrealized Gains and Unrealized Losses of Investment Securities Excluding Investments in Money Market Funds (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	$ 293,195	$ 255,441
Gross Unrealized Holding Gains	17	7
Gross Unrealized Holding Losses	(858)	(1,436)
Aggregate Fair Value	292,354	254,012
Agency Bonds [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	221,163	184,666
Gross Unrealized Holding Gains	3	2
Gross Unrealized Holding Losses	(720)	(990)
Aggregate Fair Value	220,446	183,678
Commercial Paper [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	40,994	24,767
Gross Unrealized Holding Gains	2	5
Gross Unrealized Holding Losses	(21)	(30)
Aggregate Fair Value	40,975	24,742
Treasury Bonds [Member]
Schedule of Available-for-sale Securities [Line Items]
Amortized Cost	31,038	46,008
Gross Unrealized Holding Gains	12
Gross Unrealized Holding Losses	(117)	(416)
Aggregate Fair Value	$ 30,933	$ 45,592

Balance Sheet Components - Su_2

Balance Sheet Components - Summary of Contractual Maturities of Investment Securities (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Amortized Cost, Amounts maturing within one year	$ 283,671
Amortized Cost, Amounts maturing after one year through five years	9,524
Amortized Cost	293,195	$ 255,441
Fair Value, Amounts maturing within one year	282,818
Fair Value, Amounts maturing after one year through five years	9,536
Fair Value, Total investment securities	$ 292,354	$ 254,012

Balance Sheet Components - Comp

Balance Sheet Components - Components of Inventories (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 57,477	$ 53,384
Work in porcess	2,551	1,195
Finished goods	53,265	45,059
Total inventories	$ 113,293	$ 99,638

Balance Sheet Components - Sche

Balance Sheet Components - Schedule of Property and Equipment, Net (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 53,283	$ 51,102
Less: Accumulated depreciation and amortization	(30,372)	(28,831)
Property and equipment, net	22,911	22,271
Laboratory and Manufacturing Equipment [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	11,940	11,482
Computer Equipment and Software [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	21,530	18,626
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	4,485	4,421
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	10,589	10,589
Construction in Process [Member]
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 4,739	$ 5,984

Balance Sheet Components - Sc_2

Balance Sheet Components - Schedule of Property and Equipment, Depreciation and Amortization Expense (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Property, Plant and Equipment [Abstract]
Depreciation and amortization expense	$ 1,541	$ 1,495

Balance Sheet Components - Su_3

Balance Sheet Components - Summary of Accrued Liabilities (Detail) - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022	Mar. 31, 2022	Dec. 31, 2021
Payables and Accruals [Abstract]
Accrued payroll and related expenses	$ 26,490	$ 35,341
Accrued professional fees	2,877	1,425
Accrued taxes	2,974	1,910
Accrued clinical and research expenses	235	282
Accrued interest	2,609	1,305
Accrued warranty	1,147	866	$ 452	$ 664
Accrued other	4,035	6,039
Total accrued liabilities	$ 40,367	$ 47,168

Commitments and Contingencies -

Commitments and Contingencies - Additional Information (Detail) $ in Millions	1 Months Ended				3 Months Ended
	Oct. 31, 2021 USD ($)	Aug. 31, 2020 USD ($) ft²	Dec. 31, 2016 USD ($) ft²	Mar. 31, 2015 USD ($) ft²	Mar. 31, 2023 USD ($)	Apr. 30, 2021 USD ($)
Other Commitments [Line Items]
Additional operating lease assets						$ 2.9
Additional operating lease liabilities						$ 2.9
Standard product warranty, description					limited one- to five-year warranty
Costa Rica [Member]
Other Commitments [Line Items]
Lease agreement, commencement period		2020-08
Area of office space \| ft²		35,411
Lease agreement, effective month and year		2021-04
Lease agreement, expiration period		2031-06
Lease agreement, lease expense		$ 3.9
Redwood Office Agreement [Member]
Other Commitments [Line Items]
Lease agreement, commencement period					2015-03
Area of office space \| ft²				50,000
Lease agreement, effective date				Jun. 30, 2015
Lease agreement, expiration period				2022-05
Lease expense, payment due				$ 2
Annual lease expense payable in final year of lease term				$ 2.4
Redwood Office Agreement Additional Expansion Premises [Member] \| Amendment 1 [Member]
Other Commitments [Line Items]
Area of office space \| ft²			50,000
Lease expense, payment due			$ 1.2
Annual lease expense payable in final year of lease term			$ 2.9
Commencement date description					The lease for the Expansion Premises commenced on June 1, 2018
Lease commencement date			Jun. 01, 2018
Lease agreement, expiration date			May 31, 2025
Non-cancellable Facility Lease [Member]
Other Commitments [Line Items]
Lease agreement, effective date					Mar. 01, 2017
Lease agreement, expiration date					Feb. 28, 2022
Lease agreement, lease expense					$ 0.4
Non-cancellable Facility Lease [Member] \| Amendment 1 [Member]
Other Commitments [Line Items]
Lease agreement, expiration date	May 31, 2025
Lease agreement, lease expense	$ 0.4

Commitments and Contingencies_2

Commitments and Contingencies - Schedule of Activities Related to Warranty Obligations (Detail) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Commitments and Contingencies Disclosure [Abstract]
Beginning balance	$ 866	$ 664
Provision for warranty	1,763	715
Utilization	(1,482)	(927)
Ending balance	$ 1,147	$ 452

Debt - Additional Information (

Debt - Additional Information (Detail) - 2025 Notes and Convertible Notes [Member] - USD ($)	3 Months Ended
	Mar. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Converted Value in Excess of Principal	$ 0
Debt, Liability Component [Member]
Debt Instrument [Line Items]
Principal amount	$ 189,750,000	$ 189,750,000

Debt - Net Carrying Amount of L

Debt - Net Carrying Amount of Liability Component of Convertible Debt (Detail) - 2025 Notes and Convertible Notes [Member] - Debt, Liability Component [Member] - USD ($) $ in Thousands	Mar. 31, 2023	Dec. 31, 2022
Debt Instrument [Line Items]
Principal	$ 189,750	$ 189,750
Unamortized issuance cost	(2,575)	(2,883)
Net carrying amount	$ 187,175	$ 186,867

Debt - Interest Expense Recogni

Debt - Interest Expense Recognized Related to Convertible Notes (Detail) - 2025 Notes and Convertible Notes [Member] - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Debt Instrument [Line Items]
Contractual interest expense	$ 1,305	$ 1,305
Amortization of debt issuance costs	308	298
Total interest expense	$ 1,613	$ 1,603

Stock-Based Compensation - Addi

Stock-Based Compensation - Additional Information (Details) - Performance Stock Units [Member] - Management Team [Member] - $ / shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-Based Compensation Arrangement by Share-Based Payment Award [Line Items]
Number of restricted stock units granted	175,088	392,742
Weighted average fair value of restricted stock units granted	$ 38.90	$ 54
Vesting period	3 years	3 years
Targeted composite index period	2 years
Revenue targets performance period	2 years

Stock-Based Compensation - Summ

Stock-Based Compensation - Summary of Stock-Based Compensation Expense by Line Items in Consolidated Statements of Operations (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 13,560	$ 13,408
Cost of Revenue [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	442	554
Research and Development [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	2,644	2,051
Selling, General and Administrative [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 10,474	$ 10,803

Stock-Based Compensation - Su_2

Stock-Based Compensation - Summary of Stock-Based Compensation Expense (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 13,560	$ 13,408
Stock Options [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	295	572
Restricted Stock Units [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	9,555	8,777
Performance Stock Units [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	2,832	3,314
Employee Stock Purchase Plan [Member]
Share-Based Payment Arrangement, Expensed and Capitalized, Amount [Line Items]
Stock-based compensation expense	$ 878	$ 745

Basic and Diluted Net Income _3

Basic and Diluted Net Income (Loss) Per Share - Computation of Basic and Diluted Net Loss per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Earnings Per Share [Abstract]
Net loss, basic and diluted	$ (35,029)	$ (34,325)
Weighted average shares used to compute basic net loss per share	35,584,685	35,073,862
Weighted average shares used to compute diluted net loss per share	35,584,685	35,073,862
Net loss per share, basic	$ (0.98)	$ (0.98)
Net loss per share, diluted	$ (0.98)	$ (0.98)

Basic and Diluted Net Income _4

Basic and Diluted Net Income (Loss) Per Share - Computation of Potentially Dilutive Securities Outstanding Excluded from Computation of Diluted Shares (Detail) - shares	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of diluted shares outstanding	6,624,235	5,994,757
Unreleased Restricted Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of diluted shares outstanding	2,403,168	1,691,713
Options to Purchase Common Stock [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of diluted shares outstanding	606,785	688,762
Convertible Senior Notes [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of diluted shares outstanding	1,807,141	1,807,141
Warrants Related to the Issuance of Convertible Senior Notes [Member]
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Potentially dilutive securities excluded from computation of diluted shares outstanding	1,807,141	1,807,141

Employee Benefit Plans - Additi

Employee Benefit Plans - Additional Information (Detail) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2023	Mar. 31, 2022
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expense for matching contributions	$ 2.4	$ 2.3