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Cover Page - shares	3 Months Ended
Cover Page - shares	Mar. 31, 2020	May 01, 2020
Cover [Abstract]
Document Type	10-Q
Amendment Flag	false
Document Period End Date	Mar. 31, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q1
Title of 12(b) Security	Common stock, par value $0.0001 per share
Trading Symbol	AXNX
Security Exchange Name	NASDAQ
Entity Registrant Name	Axonics Modulation Technologies, Inc.
Entity Central Index Key	0001603756
Current Fiscal Year End Date	--12-31
Entity Filer Category	Accelerated Filer
Entity Emerging Growth Company	true
Entity Small Business	true
Entity Ex Transition period	true
Entity Shell Company	false
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Common Stock, Shares Outstanding		34,518,975

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current assets
Cash and cash equivalents	$ 159,820	$ 171,082
Short-term investments	0	12,592
Accounts receivable, net of allowance for doubtful accounts of $589 and $75 at March 31, 2020 and December 31, 2019, respectively	20,770	7,879
Inventory, net	19,230	15,659
Prepaid expenses and other current assets	4,245	4,468
Total current assets	204,065	211,680
Property and equipment, net	5,406	3,047
Intangible asset, net	282	311
Other assets	7,626	4,784
Total assets	217,379	219,822
Current liabilities
Accounts payable	7,440	5,882
Accrued liabilities	3,110	2,174
Accrued compensation and benefits	3,503	3,375
Operating lease liability, current portion	794	602
Debt, current portion	5,000	0
Total current liabilities	19,847	12,033
Operating lease liability, net of current portion	9,485	4,450
Debt, net of unamortized debt issuance costs, net of current portion	15,571	20,336
Total liabilities	44,903	36,819
Stockholders’ equity
Preferred stock, par value $0.0001 per share; 10,000,000 shares authorized, no shares issued and outstanding at March 31, 2020 and December 31, 2019	0	0
Common stock, par value $0.0001, 50,000,000 shares authorized at March 31, 2020 and December 31, 2019; 34,510,662 and 34,110,995 shares issued and outstanding at March 31, 2020 and December 31, 2019, respectively	3	3
Additional paid-in capital	367,278	363,012
Accumulated deficit	(194,200)	(179,584)
Accumulated other comprehensive loss	(605)	(428)
Total stockholders’ equity	172,476	183,003
Total liabilities and stockholders’ equity	$ 217,379	$ 219,822

Condensed Consolidated Balance Sheets - (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Allowance for doubtful accounts	$ 589	$ 75
Preferred stock, par value (USD per share)	$ 0.0001	$ 0.0001
Preferred stock authorized (shares)	10,000,000	10,000,000
Preferred stock issued (shares)	0	0
Preferred stock outstanding (shares)	0	0
Common stock, par value (USD per share)	$ 0.0001	$ 0.0001
Common stock authorized (shares)	50,000,000	50,000,000
Common stock issued (shares)	34,510,662	34,110,995
Common stock outstanding (shares)	34,510,662	34,110,995

Condensed Consolidated Statements of Comprehensive Loss - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Statement of Comprehensive Income [Abstract]
Net revenue	$ 26,296	$ 1,077
Cost of goods sold	9,895	548
Gross profit	16,401	529
Operating Expenses
Research and development	6,884	4,219
General and administrative	7,653	4,015
Sales and marketing	16,569	5,914
Total operating expenses	31,106	14,148
Loss from operations	(14,705)	(13,619)
Other Income (Expense)
Interest income	642	1,034
Interest and other expense	(552)	(532)
Other income, net	90	502
Loss before income tax expense	(14,615)	(13,117)
Income tax expense	1	0
Net loss	(14,616)	(13,117)
Foreign currency translation adjustment	(177)	(10)
Comprehensive loss	$ (14,793)	$ (13,127)
Net loss per share, basic and diluted (USD per share)	$ (0.43)	$ (0.47)
Weighted-average shares used to compute basic and diluted net loss per share (shares)	33,637,646	27,828,201

Condensed Consolidated Statements of Stockholders' Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-in Capital	Accumulated Deficit	Accumulated Other Comprehensive Loss
Balance at beginning of period (shares) at Dec. 31, 2018		27,806,934
Balance at beginning of period at Dec. 31, 2018	$ 143,275	$ 3	$ 243,337	$ (99,649)	$ (416)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (shares)		41,740
Issuance of common stock for employee stock option exercises for cash	44		44
Restricted Shares Award (“RSA”) issuances and forfeitures for terminations, net (shares)		352,417
Restricted Shares Award (“RSA”) issuances and forfeitures for terminations, net	977		977
Restricted Stock Units (“RSU”) issuances and forfeitures for terminations, net	165		165
Foreign currency translation adjustment	(10)				(10)
Net loss	(13,117)			(13,117)
Balance at end of period (shares) at Mar. 31, 2019		28,201,091
Balance at end of period at Mar. 31, 2019	$ 131,334	$ 3	244,523	(112,766)	(426)
Balance at beginning of period (shares) at Dec. 31, 2019	34,110,995	34,110,995
Balance at beginning of period at Dec. 31, 2019	$ 183,003	$ 3	363,012	(179,584)	(428)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock for employee stock option exercises for cash (shares)		181,456
Issuance of common stock for employee stock option exercises for cash	344		344
Restricted Shares Award (“RSA”) issuances and forfeitures for terminations, net (shares)		171,875
Restricted Shares Award (“RSA”) issuances and forfeitures for terminations, net	3,039		3,039
Restricted Stock Units (“RSU”) issuances and forfeitures for terminations, net (shares)		46,336
Restricted Stock Units (“RSU”) issuances and forfeitures for terminations, net	883		883
Foreign currency translation adjustment	(177)				(177)
Net loss	$ (14,616)			(14,616)
Balance at end of period (shares) at Mar. 31, 2020	34,510,662	34,510,662
Balance at end of period at Mar. 31, 2020	$ 172,476	$ 3	$ 367,278	$ (194,200)	$ (605)

Condensed Consolidated Statements of Cash Flows - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Cash Flows from Operating Activities
Net loss	$ (14,616)	$ (13,117)
Adjustments to reconcile net loss to net cash used in operating activities
Depreciation and amortization	380	276
Stock-based compensation	3,922	1,142
Amortization of debt issuance costs	235	165
Provision for doubtful accounts	514	0
Changes in operating assets and liabilities
Accounts receivable	(13,405)	(377)
Inventory	(3,571)	(1,391)
Prepaid expenses and other current assets	223	938
Other assets	228	(6)
Accounts payable	1,558	(1,334)
Accrued liabilities	936	114
Accrued compensation and benefits	128	567
Lease liability	161	(32)
Net cash used in operating activities	(23,307)	(13,055)
Cash Flows from Investing Activities
Purchases of property and equipment	(714)	(350)
Purchases of short-term investments	0	(10,298)
Proceeds from sales and maturities of short-term investments	12,592	14,697
Net cash provided by investing activities	11,878	4,049
Cash Flows from Financing Activities
Proceeds from exercise of stock options	344	44
Net cash provided by financing activities	344	44
Effect of exchange rate changes on cash and cash equivalents	(177)	(10)
Net decrease in cash and cash equivalents	(11,262)	(8,972)
Cash and cash equivalents, beginning of year	171,082	98,306
Cash and cash equivalents, end of period	159,820	89,334
Supplemental Disclosure of Cash Flow Information
Cash paid for interest	329	360
Cash paid for taxes	$ 0	$ 0

Nature of Operations and Summary of Significant Accounting Policies

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Nature of Operations and Summary of Significant Accounting Policies

Nature of Operations

Axonics Modulation Technologies, Inc. (the “Company”), formerly American Restorative Medicine, Inc., was incorporated in the state of Delaware on March 2, 2012. The Company had no operations until October 1, 2013, when the license agreement between Alfred E. Mann Foundation for Scientific Research (“AMF”) and the Company (the “License Agreement”) was entered into. The Company is a medical technology company that has developed and is commercializing an innovative and minimally invasive implantable neurostimulation system. The Company has designed and developed the rechargeable sacral neuromodulation (“SNM”) system (“r-SNM System”), which delivers mild electrical pulses to the targeted sacral nerve in order to restore normal communication to and from the brain to reduce the symptoms of overactive bladder (“OAB”), urinary retention (“UR”) and fecal incontinence (“FI”). The r-SNM System is protected by intellectual property based on Company-generated innovations and patents and other intellectual property licensed from AMF. The Company has marketing approvals in the United States, Europe, Canada, and Australia for all relevant clinical indications. On September 6, 2019, the premarket approval (“PMA”) application for the r-SNM System for the treatment of FI was approved by the U.S. Food and Drug Administration (“FDA”) and on November 13, 2019, the PMA application for the r-SNM System for the treatment of OAB and UR was approved by the FDA. Accordingly, the Company began U.S. commercialization of its r-SNM System in the fourth quarter of 2019. Prior to the fourth quarter of 2019, the Company has derived revenue only from its international operations in select markets including England, the Netherlands and Canada, and its activities have consisted primarily of developing the r-SNM System, conducting its RELAX-OAB post-market clinical follow-up study in Europe, its ARTISAN-SNM pivotal clinical study in the United States and hiring and training its U.S. commercial team in preparation for the launch of the r-SNM System in the United States.

Initial Public Offering

On November 2, 2018, the Company completed its initial public offering (“IPO”) by issuing 9,200,000 shares of common stock, at an offering price of $15.00 per share, inclusive of 1,200,000 shares of the Company’s common stock issued upon the exercise by the underwriters of their option to purchase additional shares. The net proceeds were approximately $126.0 million, after deducting underwriting discounts, commissions and offering expenses payable by the Company. In connection with the IPO, the Company’s outstanding shares of convertible preferred stock were automatically converted into an aggregate of 15,813,297 shares of common stock, and the Company’s outstanding warrants to purchase shares of Series C convertible preferred stock were automatically converted into warrants to purchase up to an aggregate of 80,000 shares of common stock (see Note 5).

Follow-On Offering

On November 22, 2019, the Company completed a follow-on offering by issuing 5,345,000 shares of common stock, at an offering price of $22.00 per share, inclusive of 750,000 shares of the Company’s common stock issued upon the exercise by the underwriters of their option to purchase additional shares. The net proceeds to the Company were approximately $110.4 million, after deducting underwriting discounts, commissions and offering expenses payable by the Company.

Principles of Consolidation

The accompanying unaudited interim condensed consolidated financial statements include the accounts of the Company, its wholly-owned subsidiaries, Axonics Europe, S.A.S., Axonics Modulation Technologies U.K. Limited and Axonics Modulation Technologies Australia Pty Ltd. Intercompany accounts and transactions have been eliminated in consolidation.

Basis of Presentation

Interim Financial Statements

The interim financial statements and related footnote disclosures as of and for the three months ended March 31, 2020 are unaudited, and are not necessarily indicative of the Company’s operating results for a full year. The unaudited interim condensed consolidated financial statements include all normal and recurring adjustments necessary for a fair presentation of the Company’s financial results for the three months ended March 31, 2020 in accordance with United States (“U.S.”) generally accepted accounting principles (“GAAP”), however, certain information and footnote disclosures normally included in annual financial statements prepared in accordance with GAAP have been condensed or omitted pursuant to the U.S. Securities and Exchange Commission (“SEC”) rules and regulations relating to interim financial statements. The accompanying unaudited condensed consolidated financial statements should be read in conjunction with the Company’s audited consolidated financial statements and notes thereto included within the Company’s Annual Report on Form 10-K for the fiscal year ended December 31, 2019 (filed with the SEC on March 4, 2020).

COVID-19

The recent COVID-19 outbreak, and the resulting restrictions intended to slow the spread of COVID-19, including stay-at-home orders, business shut downs and other restrictions, has adversely affected the Company’s business in several ways. The primary impact on the Company’s business has been the delay of elective procedures to allow health care facilities to prioritize the treatment of COVID-19 patients, which has materially reduced the number of procedures using the Company’s r-SNM System. Until such time as governmental authorities recommend that it is deemed advisable for health care facilities to begin performing elective procedures, the Company expects a small number of procedures using the Company’s r-SNM System to be performed which will materially harm the Company’s revenues and increase the Company’s operating loss. If these delays in procedures lasts longer than expected, the Company may have to scale back the Company’s business, including reducing headcount, which could have a negative impact on the Company’s long term operations. Even after it is deemed advisable to resume conducting elective procedures, some patients may delay scheduling procedures to avoid traveling to health care facilities which they may feel are unsafe. The Company could also experience other negative impacts of the COVID-19 outbreak such as the lack of availability of the Company’s key personnel, temporary closures of the Company’s office or the facilities of the Company’s business partners, customers, third party service providers or other vendors, and the interruption of the Company’s supply chain, distribution channels, liquidity and capital or financial markets.

Any disruption and volatility in the global capital markets as a result of the pandemic may increase the Company’s cost of capital and adversely affect the Company’s ability to access financing when and on terms that the Company desires. In addition, a recession resulting from the spread of COVID-19 could materially affect the Company’s business, especially if a recession results in higher unemployment causing potential patients to not have access to health insurance.

The ultimate extent to which the COVID-19 pandemic and its repercussions impact the Company’s business will depend on future developments, which are highly uncertain. However, the foregoing and other continued disruptions to the Company’s business as a result of COVID-19 could result in a material adverse effect on the Company’s business, results of operations, financial condition and cash flows.

On March 27, 2020, the President signed into law the “Coronavirus Aid, Relief, and Economic Security (CARES) Act.” The CARES Act, among other things, includes provisions relating to refundable payroll tax credits, deferment of employer side social security payments, net operating loss carryback periods, alternative minimum tax credit refunds, modifications to the net interest deduction limitations, increased limitations on qualified charitable contributions, and technical corrections to tax depreciation methods for qualified improvement property. The Company currently is not eligible or has not taken advantage of the payroll protection program, emergency grants and business loans under the CARES Act. The Company will continue to monitor the impact that the CARES Act may have on the Company’s business, financial condition, results of operations, or liquidity.

Use of Estimates

The preparation of condensed consolidated financial statements in conformity with GAAP requires the Company’s management to make estimates and judgments that affect the reported amounts of assets, liabilities, and expenses, and related disclosure of contingent assets and liabilities. The Company bases its estimates on historical experience and on various other assumptions that it believes to be reasonable under the circumstances. The results of this evaluation then form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual results may differ from these estimates under different assumptions or conditions, and such differences may be material to the consolidated financial statements.

Revenue Recognition

Revenue recognized during the three months ended March 31, 2020 and 2019 relates entirely to the sale of our r-SNM System. In May 2014, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2014-09 “Revenue from Contracts with Customers” (“ASU 2014-09”) as Accounting Standards Codification (“ASC”) Topic 606. The objective of Topic 606 is to establish a single comprehensive model for entities to use in accounting for revenue arising from contracts with customers and superseded most of the existing revenue recognition guidance, including industry-specific guidance. The core principle is that a company should recognize revenue to depict the transfer of promised goods or services to customers in an amount that reflects the consideration to which the entity expects to be entitled in exchange for those goods or services. Topic 606 applies to all contracts with customers except those that are within the scope of other topics in the FASB ASC.

The Company has revenue arrangements that consist of a single performance obligation. The Company recognizes revenue at the point in time when it transfers control of promised goods to its customers. Revenue is measured as the amount of consideration it expects to receive in exchange for transferring goods. The amount of revenue that is recognized is based on the transaction price, which represents the invoiced amount and includes estimates of variable consideration such as discounts, where applicable. The Company does not offer rights of return or price protection. The amount of variable consideration included in the transaction price may be constrained and is included only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized under the contract will not occur in a future period. Payment terms, typically less than three months, are offered to the Company’s customers and do not include a significant financing component. The Company extends credit to its customers based upon an evaluation of the customer’s financial condition and credit history and generally requires no collateral. The Company does not have any contract balances related to product sales. The Company also does not have significant contract acquisition costs related to product sales.

In accordance with Company policy and based on the Company’s historical experience, no allowance for product returns has been provided. Damaged or defective products are replaced at no charge under the Company’s standard warranty. For the three months ended March 31, 2020 and 2019, the replacement costs were immaterial.

The following table provides additional information pertaining to net revenue disaggregated by geographic market for the three months ended March 31, 2020 and 2019 (in thousands):



	Three Months Ended March 31,
	2020		2019
United States	$	25,046	$	—
International markets	1,250		1,077
Total net revenue	$	26,296	$	1,077

Allowance for Doubtful Accounts

The Company makes estimates of the collectability of accounts receivable. In doing so, the Company analyzes historical bad debt trends, customer credit worthiness, current economic trends and changes in customer payment patterns when evaluating the adequacy of the allowance for doubtful accounts. Despite the Company’s efforts to minimize credit risk exposure, clients could be adversely affected if future economic and industry trends, including those related to COVID-19, change in such a manner as to negatively impact their cash flows. The full effects of COVID-19 on the Company’s clients are highly uncertain and cannot be predicted. As a result, the Company’s future collection experience can differ significantly from historical collection trends. If the Company’s clients experience a negative impact on their cash flows, it could have a material adverse effect on the Company’s results of operations and financial condition.

Cash and Cash Equivalents

Cash equivalents consist of short-term, highly liquid investments purchased with an original maturity of three months or less. Financial instruments that potentially subject the Company to a concentration of credit risk consist of cash and cash equivalents. At times, the cash and cash equivalent balances may exceed federally insured limits. The Company does not believe that this results in any significant credit risk.

Fair Value of Financial Instruments

Fair value is defined as the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date. A three-level fair value hierarchy prioritizes the inputs used to measure fair value. The hierarchy requires entities to maximize the use of observable inputs and minimize the use of unobservable inputs. The three levels of inputs used to measure fair value are as follows:


•	Level 1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities.


•	Level 2: Inputs are quoted prices for similar assets and liabilities in active markets or quoted prices for identical or similar instruments in markets that are not active and model-derived valuations in which all significant inputs and significant value drivers are observable in active markets.


•	Level 3: Inputs are unobservable inputs based on the Company’s assumptions and valuation techniques used to measure assets and liabilities at fair value. The inputs require significant management judgment or estimation.

The Company’s assessment of the significance of an input to the fair value measurement requires judgment, which may affect the valuation of fair value assets and liabilities and their placement within the fair value hierarchy levels. The carrying amounts reported in the condensed consolidated financial statements approximate the fair value for cash and cash equivalents, accounts receivable, accounts payables, and accrued expenses, due to their short-term nature. The carrying amount of the Company’s term loan, which is described below, approximates fair value, considering the interest rates are based on the prime interest rate.

Investment Securities

The Company classifies its investment securities as available-for-sale. Those investments in debt securities with maturities less than 12 months at the date of purchase are considered short-term investments. Those investments in debt securities with maturities greater than 12 months at the date of purchase are considered long-term investments. The Company’s investment securities classified as available-for-sale are recorded at fair value based on the fair value hierarchy (Level 1 and Level 2 inputs in the fair value hierarchy), and consists primarily of commercial paper, corporate notes and U.S. government and agency securities. Unrealized gains or losses, deemed temporary in nature, are reported as other comprehensive income within the condensed consolidated statement of comprehensive income (loss). There were no unrealized gains or losses during the three months ended March 31, 2020 and 2019.

A decline in the fair value of any security below cost that is deemed other than temporary results in a charge to net income (loss) and the corresponding establishment of a new cost basis for the security. Premiums (discounts) are amortized (accreted) over the life of the related security as an adjustment to yield using the straight-line interest method. Dividend and interest income are recognized when earned. Realized gains or losses are included in net income (loss) and are derived using the specific identification method for determining the cost of securities sold.

The following table presents the fair value hierarchy for those assets measured at fair value on a recurring basis as of March 31, 2020 and December 31, 2019 (in thousands):

Fair Value Measurements at March 31, 2020

Assets:

Level 1

Level 2

Level 3

Total

Commercial paper

—

Corporate notes

—

U.S. government and agency securities

—



	Fair Value Measurements at December 31, 2019
Assets:	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	7,195	$	—	$	7,195
Corporate notes	2,018		—		—		2,018
U.S. government and agency securities	3,379		—		—		3,379
	$	5,397	$	7,195	$	—	$	12,592

Foreign Currency Translation

The functional currencies of the Company’s subsidiaries are currencies other than the U.S. dollar. The Company translates assets and liabilities of the foreign subsidiaries into U.S. dollars at the exchange rate in effect on the balance sheet date. Costs and expenses of the subsidiaries are translated into U.S. dollars at the average exchange rate during the period. Gains or losses from these translation adjustments are reported as a separate component of stockholders’ equity in accumulated other comprehensive loss until there is a sale or complete or substantially complete liquidation of the Company’s investment in the foreign subsidiary at which time the gains or losses will be realized and included in net income (loss). As of March 31, 2020 and December 31, 2019, all foreign currency translation gains (losses) have been unrealized and included in accumulated other comprehensive loss. Accumulated other comprehensive loss consists entirely of losses from translation of foreign subsidiaries at March 31, 2020 and December 31, 2019. Foreign currency transaction gains and losses are included in results of operations and have not been significant for the periods presented.

Inventory, Net

Inventories are stated at the lower of cost or net realizable value, with cost computed on a first-in, first-out basis. The Company reduces the carrying value of inventories for items that are potentially excess, obsolete, or slow-moving based on changes in customer demand, technology developments, or other economic factors.

The Company capitalizes inventory produced for commercial sale. The Company capitalizes manufacturing costs as inventory following both the receipt of regulatory approval from regulatory bodies and the Company’s intent to commercialize. Costs associated with developmental products prior to satisfying the Company’s inventory capitalization criteria are charged to research and development expense as incurred.

Products that have been approved by certain regulatory authorities are also used in clinical programs to assess the safety and efficacy of the products for usage that have not been approved by the FDA or other regulatory authorities. The form of product utilized for both commercial and clinical programs is identical and, as a result, the inventory has an “alternative future use” as defined in authoritative guidance. Component materials and purchased products associated with clinical development programs are included in inventory and charged to research and development expense when the product enters the research and development process and no longer can be used for commercial purposes and, therefore, does not have an “alternative future use.”

For products that are under development and have not yet been approved by regulatory authorities, purchased component materials are charged to research and development expense when the inventory ownership transfers to the Company.

The Company analyzes inventory levels to identify inventory that may expire prior to sale, inventory that has a cost basis in excess of its net realizable value, or inventory in excess of expected sales requirements. Although the manufacturing of the r-SNM System is subject to strict quality control, certain batches or units of product may no longer meet quality specifications or may expire, which would require adjustments to the Company’s inventory values. The Company also applies judgment related to the results of quality tests that are performed throughout the production process, as well as the understanding of regulatory guidelines, to determine if it is probable that inventory will be saleable. These quality tests are performed throughout the pre- and post-production processes, and the Company continually gathers information regarding product quality for periods after the manufacturing date. The r-SNM System currently has a maximum estimated shelf life range of 12 to 27 months and, based on sales forecasts, the Company expects to realize the carrying value of the product inventory. In the future, reduced demand, quality issues, or excess supply beyond those anticipated by management may result in a material adjustment to inventory levels, which would be recorded as an increase to cost of sales.

The determination of whether or not inventory costs will be realizable requires estimates by the Company’s management. A critical input in this determination is future expected inventory requirements based on internal sales forecasts. Management then compares these requirements to the expiry dates of inventory on hand. To the extent that inventory is expected to expire prior to being sold, management will write down the value of inventory.

As of March 31, 2020, the Company had $7.5 million, $1.2 million and $10.5 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively, on hand net of reserves of $0.1 million. As of December 31, 2019, the Company had $7.0 million, $1.5 million and $7.2 million of finished goods inventory, work-in-process inventory and raw materials inventory, respectively, on hand net of reserves of $0.1 million.

Property and Equipment

Property and equipment are stated at cost less accumulated depreciation. Depreciation is computed using the straight-line method over the estimated useful lives of the assets, generally between three and seven years. Leasehold improvements are amortized over the lesser of the life of the lease or the useful life of the improvements. Maintenance and repairs are charged to expense as incurred. When assets are retired or otherwise disposed of, the cost and accumulated depreciation are removed from the balance sheet and any resulting gain or loss is reflected in operations.

Intangible Asset

The intangible asset represents exclusive rights to an additional field-of-use on the patent suite within the License Agreement with AMF. The additional field-of-use was provided in exchange for 50,000 shares of Series A preferred stock, the fair value of which was $1.0 million in 2013. The intangible asset was recorded at its fair value of $1.0 million at the date contributed. In connection with the IPO, such shares of Series A preferred stock were converted into common stock. Amortization of this asset is recorded over the shorter of the patent or legal life on a straight-line basis. The weighted-average amortization period is 8.71 years. Accumulated amortization of the intangible asset is $0.7 million at March 31, 2020 and December 31, 2019. The amortization of the intangible asset was minimal during the three months ended March 31, 2020 and 2019. The Company will review the intangible asset for impairment whenever an impairment indicator exists. There have been no intangible asset impairment charges to date.

Impairment of Long-Lived Assets

The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability is measured by comparing the carrying amount to the future net cash flows that the assets are expected to generate. If said assets are considered to be impaired, the impairment that would be recognized is measured by the amount by which the carrying amount of the assets exceeds the projected discounted future net cash flows arising from the asset. There have been no such impairments of long-lived assets to date.

Leases

Effective January 1, 2018, the Company early adopted ASU No. 2016-02, “Leases (Topic 842)”, the comprehensive new lease standard issued by the FASB. The most significant impact was the recognition of right-of-use (“ROU”) assets and lease liabilities for operating leases. The Company determines if an arrangement is a lease at inception and includes operating leases on the Company’s consolidated balance sheets. The operating lease ROU asset is included within the Company’s other non-current assets, and lease liabilities are included in current or noncurrent liabilities on the Company’s condensed consolidated balance sheets.

The Company has made certain policy elections to apply to its leases executed post-adoption, or subsequent to January 1, 2018. In accordance with Topic 842, components of a lease should be split into three categories: lease components, non-lease components, and non-components. The fixed and in-substance fixed contract consideration (including any consideration related to non-components) must be allocated based on the respective relative fair values to the lease components and non-lease components. Entities may elect not to separate lease and non-lease components. Rather, entities would account for each lease component and related non-lease component together as a single lease component. The Company has elected to account for lease and non-lease components together as a single lease component for all underlying assets and allocate all of the contract consideration to the lease component only. Topic 842 allows for the use of judgment in determining whether the assumed lease term is for a major part of the remaining economic life of the underlying asset and whether the present value of lease payments represents substantially all of the fair value of the underlying asset. The Company applies the bright line thresholds referenced in Topic 842 to assist in evaluating leases for appropriate classification. The aforementioned bright lines are applied consistently to the Company’s entire portfolio of leases.

Operating lease ROU asset and operating lease liabilities are recognized based on the present value of the future minimum lease payments over the lease term at commencement date. As the Company’s lease does not provide an implicit rate, the Company uses its incremental borrowing rate based on the information available at commencement date in determining the present value of future payments. The operating lease ROU asset also includes any lease payments made and excludes lease incentives and initial direct costs incurred. The lease terms may include options to extend or terminate the lease when it is reasonably certain that the Company will exercise that option. Lease expense for minimum lease payments is recognized on a straight-line basis over the lease term. As of March 31, 2020 and December 31, 2019, the weighted-average remaining lease terms for the Company’s operating leases were 7.6 years and 7.8 years, respectively. The weighted-average discount rate used to determine the present value of the Company’s operating leases’ future payments was 6.9% and 7.25% as of March 31, 2020 and December 31, 2019, respectively (see Note 3 regarding leases).

Research and Development

Research and development costs are charged to operations as incurred. Research and development costs include salary and personnel-related costs, costs of clinical studies and testing, supplies and materials, and outside consultant costs.

Income Taxes

The Company accounts for income taxes using the asset and liability method to compute the difference between the tax basis of assets and liabilities and the related financial amounts, using currently enacted tax rates. The Company has deferred tax assets. The realization of these deferred tax assets is dependent upon the Company’s ability to generate sufficient taxable income in future years. Valuation allowances are established, when necessary, to reduce deferred tax assets to the amount that more likely than not will be realized. The Company evaluates the recoverability of the deferred tax assets annually, and maintains a full valuation allowance on its deferred tax assets. The Company recognizes the tax benefit from an uncertain tax position only if it is more likely than not that the tax position will be sustained on examination by taxing authorities, based on the technical merits of the position. The Company has determined that it has no uncertain tax positions.

Stock-Based Compensation

The Company measures the cost of employee and non-employee services in exchange for an award of equity instruments based on the grant-date fair value of the award and recognizes compensation cost over the requisite service period (typically the vesting period), generally four years. Forfeitures are estimated at the time of the grant and revised in subsequent periods to reflect differences between the estimates and the number of shares that actually become exercisable.

The Company uses the Black-Scholes option pricing model to determine the fair value of stock options (as of the date of grant) that have service conditions for vesting. Stock options and restricted shares awards vest based on service conditions, typically over four years.

The Company also grants shares of performance-based restricted stock units that typically cliff vest after one year only if the Company has also achieved certain performance objectives as defined and approved by the Company’s board of directors. Performance awards are expensed over the performance period based on the probability of achieving the performance objectives. In addition, the Company also grants market-based restricted stock units that have combined market conditions and service conditions for vesting, for which the Company uses the Monte Carlo valuation model to value equity awards (as of the date of grant).

Net Loss per Share of Common Stock

Basic net loss per share of common stock is calculated by dividing the net loss attributable to common stockholders by the weighted-average number of shares of common stock outstanding during the period, without consideration for potentially dilutive securities. Diluted net loss per share is computed by dividing the net loss attributable to common stockholders by the weighted-average number of shares of common stock and potentially dilutive securities outstanding for the period. For purposes of the diluted net loss per share calculation, convertible preferred stock, common and preferred stock warrants, common stock options, unvested RSAs and RSUs are considered to be potentially dilutive securities. Because the Company has reported a net loss in all periods presented, diluted net loss per share of common stock is the same as basic net loss per share of common stock for those periods.

For the three months ended March 31, 2020 and 2019, there were 2,288,736 and 1,406,062 potentially dilutive weighted-average shares, respectively, that were not included in the computation of diluted weighted-average shares of common stock and common stock equivalent shares outstanding because their effect would have been antidilutive given the Company’s net loss.

Recent Accounting Pronouncements

In June 2018, the FASB issued ASU No. 2018-07, “Compensation-Stock Compensation (Topic 718): Improvements to Nonemployee Share-Based Payment Accounting”, which expands guidance on accounting for share-based payment awards, which includes share-based payment transactions for acquiring goods and services from nonemployees and aligns the accounting for share-based payments for employees and non-employees. This guidance is effective for annual periods beginning after December 15, 2018, which was the Company’s first quarter of fiscal year 2019, with early adoption permitted. The guidance should be applied to new awards granted after the date of adoption. The adoption of this guidance did not have an impact on the Company’s consolidated financial statements or related disclosures.

Property and Equipment

3 Months Ended

Mar. 31, 2020

Property, Plant and Equipment [Abstract]

Property and Equipment

Property and equipment, net consists of the following (in thousands) at:



	March 31,			December 31,
	2020			2019
Research and development equipment	$	1,176		$	1,086
Computer hardware and software	1,621			1,418
Tools and molds	1,305			1,303
Leasehold improvements	3,506			1,500
Furniture and fixtures	1,152			624
Construction in progress	58			176
	8,818			6,107
Less: accumulated depreciation and amortization	(3,412		)	(3,060		)
	$	5,406		$	3,047

Depreciation and amortization expense of property and equipment was $0.4 million and $0.2 million for the three months ended March 31, 2020 and 2019, respectively.

Commitments and Contingencies

3 Months Ended

Mar. 31, 2020

Commitments and Contingencies Disclosure [Abstract]

Commitments and Contingencies

Operating Leases

In August 2014, the Company entered into a five-year operating lease for approximately 12,215 square feet of office space beginning on November 1, 2014, and expiring on October 31, 2019. In June 2019, the lease was amended to extend the expiration date to October 31, 2020. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the discount rate at the modification date and recorded ROU assets for the same amount. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term.

In November 2017, the Company entered into a seven-year operating lease for approximately 25,548 square feet of office space beginning on August 1, 2018, and expiring on August 31, 2025. In June 2019, the lease was amended to extend the expiration date to October 31, 2027. Upon the execution of the amendment, which was deemed to be a lease modification, the Company reassessed the lease liability using the discount rate at the modification date and recorded ROU assets for the same amount. The Company also reassessed the lease classification and concluded that the lease continues to be an operating lease. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term. The Company has a renewal option to extend the term of the lease for a period of five years beyond the initial term. Under the terms of the lease, the base rent payable with respect to each renewal term will be equal to the prevailing market rental rent as of the commencement of the applicable renewal term. In the event of a default of certain of the Company’s obligations under the lease, the Company’s landlord would have the right to terminate the lease.

In June 2019, the Company entered into an eight-year operating lease (the “New Lease”) for approximately 32,621 square feet of office space beginning on January 15, 2020 and expiring on January 31, 2028 (the “Initial Term”). The Company intends to use these premises as its new principal executive offices and for general office space. The Company intends to utilize its other currently-leased spaces through the lease expiration dates to conduct the training of its sales team and for manufacturing purposes. Under the terms of the lease, the Company is responsible for taxes, insurance, and maintenance expense. The lease contains certain scheduled rent increases. Rent expense is recognized on a straight-line basis over the expected lease term. The Company has a renewal option to extend the term of the New Lease for a period of five years (the “Renewal Term”) beyond the Initial Term. Under the terms of the New Lease, the base rent payable with respect to each Renewal Term will be equal to the prevailing market rental rent as of the commencement of the applicable Renewal Term. In the event of a default of certain of the Company’s obligations under the New Lease, the Company’s landlord would have the right to terminate the New Lease.

During the three months ended March 31, 2020, ROU assets obtained in exchange for new operating lease liabilities were $3.0 million. There were no ROU assets obtained in exchange for new operating lease liabilities during the three months ended March 31, 2019. As of March 31, 2020 and December 31, 2019, the ROU asset has a balance of $7.0 million and $4.2 million, respectively. The operating lease ROU asset is included within the Company’s other non-current assets, and lease liabilities are included in current or noncurrent liabilities on the Company’s condensed consolidated balance sheets. During the three months ended March 31, 2020 and 2019, cash paid for amounts included in operating lease liabilities were $0.3 million and $0.2 million, respectively. Amortization of the ROU asset was $0.2 million and $0.1 million for the three months ended March 31, 2020 and 2019.

As of March 31, 2020 and December 31, 2019, the weighted-average remaining lease term for the Company’s operating leases were 7.6 years and 7.8 years, respectively. The weighted-average discount rate used to determine the present value of the Company’s operating leases’ future payments was 6.9% and 7.25% as of March 31, 2020 and December 31, 2019, respectively.

Total lease cost for the three months ended March 31, 2020 and 2019 are as follows (in thousands):



	Three Months Ended March 31,
	2020		2019
Lease cost
Operating lease cost	$	491	$	240
Short-term lease cost	39		55
Variable lease cost	23		13
Total lease cost	$	553	$	308

License Agreement

In October 2013, the Company entered into the License Agreement, pursuant to which AMF licensed the Company certain patents and know-how (collectively, the “AMF IP”) relating to, in relevant part, an implantable pulse generator and related system components in development by AMF as of that date, in addition to any peripheral or auxiliary devices, including all components, that when assembled, comprise such device, excluding certain implantable pulse generators (collectively, the “AMF Licensed Products”). The license to the AMF IP allows the Company to make, have made, lease, offer to lease, use, sell, offer for sale, market, promote, advertise, import, research, develop and commercialize the AMF Licensed Products worldwide for the treatment of (i) chronic pain in humans through the application of electrical energy to the nervous system, (ii) inflammatory conditions of the human body through the application of electrical energy to the vagus nerve, a nerve that interfaces with parasympathetic control of the heart, lungs and digestive tract and (iii) bladder and bowel dysfunction in humans through the application of electrical energy anywhere in or on the human body, excluding, in each case, any product or method that involves the placement of electrodes or the administration of electrical stimulation inside the cranial cavity or to the ocular nervous system or the auditory nervous system. The Company has the right to expand the field of use for the AMF Licensed Products to the modulation of digestive process and treatment of digestive conditions in humans through the application of electrical energy anywhere in or on the body, subject to the exclusions described above. Under the License Agreement, for each calendar year beginning in 2018, the Company is obligated to pay AMF a royalty on an AMF Licensed Product-by-AMF Licensed Product basis if one of the following conditions applies: (i) one or more valid claims within any of the patents licensed to the Company by AMF covers such AMF Licensed Products or the manufacture of such AMF Licensed Products or (ii) for a period of 12 years from the first commercial sale anywhere in the world of such AMF Licensed Product, in each case. The foregoing royalty is calculated as the greater of (a) 4% of all net revenue derived from the AMF Licensed Products, and (b) the Minimum Royalty, payable quarterly. The Minimum Royalty will automatically increase each year after 2018, subject to a maximum amount of $200,000 per year. The Company generated net revenue of $26.3 million and $1.1 million during the three months ended March 31, 2020 and 2019, and accrued related royalties of $1.0 million during the three months ended March 31, 2020. The Company recorded minimal related royalties during the three months ended March 31, 2019. Accrued royalty is included within accrued liabilities on the Company’s condensed consolidated balance sheets.

Legal Matters

On November 4, 2019, Medtronic, Inc., Medtronic Puerto Rico Operations Co., Medtronic Logistics LLC and Medtronic USA, Inc. (collectively, the “Medtronic Affiliates”) filed an initial complaint against the Company in the United States District Court for the Central District of California, Case No. 8:19-cv-2115 and amended the complaint on November 26, 2019. The Company refers to this matter as the Medtronic Litigation. The complaint asserts that the Company’s r-SNM System infringes U.S. Patent Nos. 8,036,756, 8,626,314, 9,463,324 and 9,821,112 held by the Medtronic Affiliates, the amended complaint further includes the additional patents 8,738,148; 8,457,758; and 7,774,069 (collectively, the “Medtronic Patents”). The Medtronic Litigation requests customary remedies for patent infringement, including (i) a judgment that the Company has infringed and is infringing the Medtronic Patents, (ii) damages, including treble damages for willful infringement, (iii) attorneys’ fees, (iv) a permanent injunction preventing the Company from infringing the Medtronic Patents and (v) costs and expenses. The Company intends to vigorously defend itself against these claims. Given the early stage of the Medtronic Litigation, the Company is unable to predict the likelihood of success of the claims of the Medtronic Affiliates against the Company or to quantify any risk of loss. The Medtronic Litigation could last for an extended period of time and require the Company to dedicate significant financial resources and management resources to its defense. An adverse ruling against the Company could materially and adversely affect its business, financial position, results of operations or cash flows and could also result in reputational harm. Even if the Company is successful in defending against these claims, the Medtronic Litigation could result in delays in future product developments, reputational harm or other collateral consequences.

On March 16, 2020, the Company filed seven petitions before the United States Patent and Trademark Office (“USPTO”) requesting inter partes review (“IPR”) to contest the validity of each of the Medtronic patents has alleged to be infringed by Axonics. The timing of the IPR process is defined by statute. In most circumstances, the USPTO will take six months to determine whether to institute an IPR petition. If instituted, the USPTO will usually render a decision on the validity of a contested patent within twelve months of instituting the review. The Company filed a motion to stay the proceedings before the United States District Court for the Central District of California pending resolution of the IPR process. The Company's motion is under consideration by the court.

In addition to the Medtronic Litigation, the Company may be involved in litigation relating to claims arising out of its operations in the normal course of business.

Long-Term Debt

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Long-Term Debt

In February 2018, the Company entered into the Loan and Security Agreement (the “Loan Agreement”), with Silicon Valley Bank, providing for a term loan (the “Term Loan”). Pursuant to the Loan Agreement, the Company may request up to $20.0 million in three tranches of term loans with such drawn obligations maturing on June 1, 2021. The Company requested $10.0 million from the first tranche, simultaneously with the entry into the Loan Agreement, which is currently outstanding. The Company may request (a) an additional $5.0 million (“Tranche B”), after the date commencing on the later of (i) the date that the Company achieves positive three-month results in the Company’s ARTISAN-SNM pivotal study, as confirmed to Silicon Valley Bank by a member of the Company’s management team and a member of its board of directors, and (ii) July 1, 2018, and ending on December 31, 2018 and (b) another $5.0 million (“Tranche C”), after the date commencing on the later of (i) the date that Silicon Valley Bank receives evidence, in form and substance reasonably satisfactory to Silicon Valley Bank, that the Company has received its pre-market approval (“PMA”) in the United States for its r-SNM System or gross proceeds from the sale of its equity securities of not less than $20.0 million, and (ii) January 1, 2019, and ending on March 31, 2019, subject to certain terms and conditions. If either Tranche B or Tranche C is drawn, then the maturity of the Term Loan is automatically extended to December 1, 2021.

The Loan Agreement provides for monthly interest payments through December 31, 2018; provided that, (i) if the Company requests and Silicon Valley Bank funds Tranche B or Tranche C, this interest-only period automatically extends through June 30, 2019, and (ii) if the Company has received a PMA in the United States for its r-SNM System and the Company requests and Silicon Valley Bank funds Tranche C, the interest-only period automatically extends through December 31, 2019. On the first day of the end of the interest-only period, the Company will be required to repay the Term Loan in equal monthly installments of principal plus interest through maturity. Outstanding principal balances under the Term Loan bear interest at the prime rate plus 1.75%.

In October 2018, the Company and Silicon Valley Bank entered into an amendment to the Loan Agreement (the “Loan Amendment”) in connection with which the Company requested the full $5.0 million from Tranche B and the full $5.0 million from Tranche C. The Company received the $10.0 million from both tranches in October 2018. Pursuant to the Loan Amendment, Silicon Valley Bank agreed to (i) extend the interest only period from June 30, 2019 to December 31, 2019, without requiring the receipt of the Company’s PMA in the United States for the r-SNM System, and (ii) make Tranche C available immediately instead of January 1, 2019. In addition, as a result of the Company’s request of the full $5.0 million from Tranche B and the full $5.0 million from Tranche C, the maturity of the Term Loan has been automatically extended to December 1, 2021. The transaction was accounted for as a debt modification. See Note 5 for discussion regarding stock warrants granted in connection with the Term Loan.

In December 2019, the Company and Silicon Valley Bank entered into a second amendment to the Loan Agreement (the “Second Amendment”). Pursuant to the Second Amendment, Silicon Valley Bank agreed to extend the interest only period from December 31, 2019 to December 31, 2020. In connection with the Second Amendment, the Company paid Silicon Valley Bank a non-refundable fee of $0.2 million. The transaction was accounted for as a debt modification.

The Company may prepay amounts outstanding under the Term Loan in increments of $5.0 million at any time with 30 days prior written notice to Silicon Valley Bank. However, all prepayments of the Term Loan prior to maturity, whether voluntary or mandatory (acceleration or otherwise), are also subject to the payment of a prepayment fee equal to (i) for a prepayment made on or after the closing date through and including the first anniversary of the closing date, 3.00% of the principal amount of the Term Loan being prepaid, (ii) for a prepayment made after the date which is the first anniversary of the closing date through and including the second anniversary of the closing date, 2.00% of the principal amount of the Term Loan being prepaid, and (iii) for a prepayment made after the date which is the second anniversary of the closing date and before the maturity date, 1.00% of the principal amount of the Term Loan being prepaid. Additionally, on the earliest to occur of (i) the maturity date of the Term Loan, (ii) the acceleration of the Term Loan, or (iii) the prepayment of the Term Loan, the Company will be required to make a final payment equal to the original principal amount of such tranche multiplied by 7.50%. The Company is currently accruing the portion of the final payment calculated based on the amount outstanding under the Term Loan.

All obligations under the Term Loan are secured by a first priority lien on substantially all of the Company’s assets, excluding intellectual property assets and more than 65% of the shares of voting capital stock of any of its foreign subsidiaries. The Company has agreed with Silicon Valley Bank not to encumber its intellectual property assets without Silicon Valley Bank’s prior written consent unless a security interest in the underlying intellectual property is necessary to have a security interest in the accounts and proceeds that are part of the assets securing the Term Loan, in which case the Company’s intellectual property shall automatically be included within the assets securing the Term Loan. As of March 31, 2020, the Company was in compliance with all debt covenant requirements under the Term Loan.

Debt, net of unamortized debt issuance costs, consists of the following (in thousands) at:



	March 31,			December 31,
	2020			2019
Debt, principal	$	20,000		$	20,000
Accrued loan fees	1,500			1,500
Debt, total	21,500			21,500
Less: unamortized debt issuance costs	(929		)	(1,164		)
Debt, net of unamortized debt issuance costs	20,571			20,336
Less: debt, current portion	(5,000		)	—
Debt, net of unamortized debt issuance costs, net of current portion	$	15,571		$	20,336

Stock-based Compensation

3 Months Ended

Mar. 31, 2020

Equity [Abstract]

Stock-based Compensation

Stock-based compensation expense included in the Company’s condensed consolidated statements of comprehensive loss is allocated as follows (in thousands):



	Three Months Ended March 31,
	2020		2019
Research and development	$	786	$	221
General and administrative	1,741		645
Sales and marketing	1,395		276
	$	3,922	$	1,142

Stock Option Activity

The option awards issued under the 2014 Stock Option Plan (the “2014 Plan”) and the 2018 Omnibus Incentive Plan (the “2018 Plan”) were measured based on fair value. The Company’s fair value calculations were made using the Black-Scholes option pricing model with the following assumptions:



	Three Months Ended March 31,
	2020	2019
Expected term (in years)	6.05	5.50 - 6.16
Stock volatility	72.01%	70.81%
Risk-free interest rate	1.37%	2.26% - 2.56%
Dividend rate	—	—

The Company used the simplified method of determining the expected term of stock options. The expected stock price volatility assumption was determined by examining the historical volatilities for industry peers, as the Company did not have sufficient trading history for the Company’s common stock. The Company will continue to analyze the historical stock price volatility and expected term assumption as more historical data for the Company’s common stock becomes available. The risk-free interest rate assumption is based on the U.S. Treasury instruments, whose term was consistent with the expected term of the Company’s stock options. The expected dividend assumption is based on the Company’s history and expectation of dividend payouts. The assumptions regarding the expected term of the options and the expected volatility of the stock price are subjective, and these assumptions have a significant effect on the estimated fair value amounts. The weighted-average grant date fair value of options granted was $18.56 and $10.69 for the three months ended March 31, 2020 and 2019, respectively.

As of March 31, 2020 and December 31, 2019, there was $17.6 million and $19.5 million, respectively, of total unrecognized compensation cost related to unvested stock options that is expected to be recognized over a weighted-average period of approximately 3.1 years and 3.2 years, respectively.

The following table summarizes stock option activity under the 2014 and 2018 Plans (in thousands, except share and per share data):



	Number of Options		Weighted-Average Exercise Price Per Share		Aggregate Intrinsic Value
Outstanding at December 31, 2019	2,847,101		$	13.22
Options granted	5,000		29.03
Options exercised	(181,456	)	1.90		$	5,114	⁽¹⁾
Options forfeited	(9,261	)	22.62
Outstanding at March 31, 2020	2,661,384		$	13.99	$	33,358	⁽²⁾

_____________________________________________


(1)	Represents the total difference between the Company’s closing stock price at the time of exercise and the stock option exercise price, multiplied by the number of options exercised.


(2)	Represents the total difference between the Company’s closing stock price on the last trading day of the first quarter of 2020 and the stock option exercise price, multiplied by the number of in-the-money options as of March 31, 2020. The amount of intrinsic value will change based on the fair market value of the Company’s stock.

The weighted-average remaining contractual term of options outstanding and exercisable is 7.8 years and 7.6 years at March 31, 2020 and December 31, 2019, respectively.

Restricted Shares Awards Activity

As of March 31, 2020 and December 31, 2019, there was $14.9 million and $11.8 million, respectively, of total unrecognized compensation cost related to unvested restricted shares awards that is expected to be recognized over a weighted-average period of approximately 3.5 years and 3.3 years, respectively.

The following table summarizes restricted shares awards activity:



	Number of Restricted Shares Awards		Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2019	586,166		$	23.59
Restricted shares awards granted	178,500		24.26
Restricted shares awards vested	(70,880	)	18.83
Restricted shares awards forfeited	(6,625	)	21.12
Outstanding at March 31, 2020	687,161		$	24.21

Restricted Stock Units Activity

As of March 31, 2020 and December 31, 2019, there was $3.6 million and $4.3 million, respectively, of total unrecognized compensation cost related to unvested restricted stock units that is expected to be recognized over a weighted-average period of approximately 1.3 years and 1.5 years, respectively.

The following table summarizes restricted stock units activity:



	Number of Restricted Stock Units		Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2019	248,104		$	21.48
Restricted stock units granted	8,000		29.03
Restricted stock units vested	(46,336	)	$	14.19
Outstanding at March 31, 2020	209,768		$	23.37

Warrant Exercise

On July 16, 2019, the Company issued and sold 32,529 shares of its common stock to SVB Financial Group (“SVB”) in connection with the exercise by SVB of its right to purchase 40,000 shares of common stock under that certain warrant, dated as of February 6, 2018. The exercise price per share was $7.50, and was paid by SVB via forfeiture of shares pursuant to a cashless exercise provision in the warrant.

On May 29, 2019, the Company issued and sold 31,071 shares of its common stock to Life Science Loans II, LLC (“Life Science Loans”) in connection with the exercise by Life Science Loans of its right to purchase 40,000 shares of common stock under that certain warrant, dated as of February 6, 2018. The exercise price per share was $7.50, and was paid by Life Science Loans via forfeiture of shares pursuant to a cashless exercise provision in the warrant.

No warrants were outstanding at March 31, 2020.

Income Taxes	3 Months Ended
Income Taxes	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes The Company used an annual effective tax rate approach to calculate income taxes for the three months ended March 31, 2020 and 2019. The annual effective tax rate of approximately 0% differs from the federal statutory tax rate due primarily to providing a full valuation allowance on net deferred tax assets. At December 31, 2019, the Company had federal and California net operating loss (“NOL”) carryforwards of approximately $162.5 million. Pursuant to Sections 382 and 383 of the Internal Revenue Code of 1986, as amended (the “Internal Revenue Code”), use of the Company’s NOL carryforwards may be limited if the Company experiences a cumulative change in ownership of greater than 50% in a rolling three-year period. The Company has not performed an analysis of changes in ownership for purposes of these Internal Revenue Code sections. Ownership changes could impact the Company’s ability to utilize NOL carryforwards remaining at an ownership change date. The Company’s NOL carryforwards were generated from domestic operations. The federal NOLs from the 2013-2017 tax years will expire between 2033 and 2037 and NOLs from 2018-2019 will carryover indefinitely. The state NOLs will expire between 2033 and 2039. At December 31, 2019, the Company also had research and development tax credit carryforwards of approximately $2.0 million, which will expire in 2036 to 2039. Approximately $0.9 million of these research and development tax credit carryforwards are included in prepaid expenses and other current assets on the Company’s consolidated balance sheets at March 31, 2020 and December 31, 2019, as they are expected to be utilized in 2020 as a credit to offset payroll taxes. The remaining amount of research and development tax credit carryforwards are included in net deferred tax assets. CARES Act The CARES Act includes provisions to support businesses in the form of loans, grants, and tax changes, among other types of relief. The Company has reviewed the income tax changes included in the CARES Act, which primarily includes the expansion of the carryback period for NOLs, changes to the deduction and limitation on interest, and acceleration of depreciation for Qualified Improvement Property. The Company has analyzed these changes and does not believe there will be a material effect on the Company’s income tax provision.

Employee Benefit Plan	3 Months Ended
Employee Benefit Plan	Mar. 31, 2020
Retirement Benefits [Abstract]
Employee Benefit Plan	Employee Benefit Plan The Company sponsors a defined contribution retirement savings plan under Section 401(k) of the Internal Revenue Code. This plan covers all employees who meet minimum age and service requirements, and allows participants to defer a portion of their annual compensation on a pre- or post-tax basis. Contributions to the plan by the Company may be made at the discretion of the board of directors. During the three months ended March 31, 2020 and 2019, the Company contributions to the plan amounted to $0.4 million and $0.1 million, respectively.

Related Party Transactions	3 Months Ended
Related Party Transactions	Mar. 31, 2020
Related Party Transactions [Abstract]
Related Party Transactions	Related Party Transactions The Company has a License Agreement and corresponding royalties incurred with AMF, which is also a stockholder of the Company. For additional information, see Note 3. The Company incurred no amount and minimal amounts during the three months ended March 31, 2020 and 2019, respectively, to a scientific advisor who is also a stockholder of the Company. There were no amounts payable to this advisor at March 31, 2020 and December 31, 2019. The Company incurred no amount and $0.1 million during the three months ended March 31, 2020 and 2019, respectively, for engineering and design services to a company that is owned by a stockholder of the Company. There were no amounts payable to this company at March 31, 2020 and December 31, 2019.

Nature of Operations and Summary of Significant Accounting Policies (Policies)

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Principles of Consolidation

Basis of Presentation

Interim Financial Statements

Use of Estimates

Revenue Recognition

Allowance for Doubtful Accounts

Cash and Cash Equivalents

Fair Value of Financial Instruments


•	Level 1: Inputs are unadjusted quoted prices in active markets for identical assets or liabilities.


•	Level 2: Inputs are quoted prices for similar assets and liabilities in active markets or quoted prices for identical or similar instruments in markets that are not active and model-derived valuations in which all significant inputs and significant value drivers are observable in active markets.


•	Level 3: Inputs are unobservable inputs based on the Company’s assumptions and valuation techniques used to measure assets and liabilities at fair value. The inputs require significant management judgment or estimation.

Investment Securities

Foreign Currency Translation

Inventory, Net

Property and Equipment

Intangible Asset

Impairment of Long-Lived Assets

Leases

Research and Development

Income Taxes

Stock-Based Compensation

Net Loss per Share of Common Stock

Recent Accounting Pronouncements

Nature of Operations and Summary of Significant Accounting Policies (Tables)

3 Months Ended

Mar. 31, 2020

Organization, Consolidation and Presentation of Financial Statements [Abstract]

Schedule of Revenue Disaggregated by Geographic Market

The following table provides additional information pertaining to net revenue disaggregated by geographic market for the three months ended March 31, 2020 and 2019 (in thousands):



	Three Months Ended March 31,
	2020		2019
United States	$	25,046	$	—
International markets	1,250		1,077
Total net revenue	$	26,296	$	1,077

Schedule of Fair Value Hierarchy for Assets Measured on Recurring Basis

The following table presents the fair value hierarchy for those assets measured at fair value on a recurring basis as of March 31, 2020 and December 31, 2019 (in thousands):

Fair Value Measurements at March 31, 2020

Assets:

Level 1

Level 2

Level 3

Total

Commercial paper

—

Corporate notes

—

U.S. government and agency securities

—



	Fair Value Measurements at December 31, 2019
Assets:	Level 1		Level 2		Level 3		Total
Commercial paper	$	—	$	7,195	$	—	$	7,195
Corporate notes	2,018		—		—		2,018
U.S. government and agency securities	3,379		—		—		3,379
	$	5,397	$	7,195	$	—	$	12,592

Property and Equipment (Tables)

3 Months Ended

Mar. 31, 2020

Property, Plant and Equipment [Abstract]

Schedule of Property and Equipment, Net

Property and equipment, net consists of the following (in thousands) at:



	March 31,			December 31,
	2020			2019
Research and development equipment	$	1,176		$	1,086
Computer hardware and software	1,621			1,418
Tools and molds	1,305			1,303
Leasehold improvements	3,506			1,500
Furniture and fixtures	1,152			624
Construction in progress	58			176
	8,818			6,107
Less: accumulated depreciation and amortization	(3,412		)	(3,060		)
	$	5,406		$	3,047

Commitments and Contingencies (Tables)

3 Months Ended

Mar. 31, 2020

Commitments and Contingencies Disclosure [Abstract]

Schedule of Total Lease Cost

Total lease cost for the three months ended March 31, 2020 and 2019 are as follows (in thousands):



	Three Months Ended March 31,
	2020		2019
Lease cost
Operating lease cost	$	491	$	240
Short-term lease cost	39		55
Variable lease cost	23		13
Total lease cost	$	553	$	308

Long-Term Debt (Tables)

3 Months Ended

Mar. 31, 2020

Debt Disclosure [Abstract]

Schedule of Debt, Net of Unamortized Debt Issuance Costs

Debt, net of unamortized debt issuance costs, consists of the following (in thousands) at:



	March 31,			December 31,
	2020			2019
Debt, principal	$	20,000		$	20,000
Accrued loan fees	1,500			1,500
Debt, total	21,500			21,500
Less: unamortized debt issuance costs	(929		)	(1,164		)
Debt, net of unamortized debt issuance costs	20,571			20,336
Less: debt, current portion	(5,000		)	—
Debt, net of unamortized debt issuance costs, net of current portion	$	15,571		$	20,336

- Definition

Tabular disclosure of long-debt instruments or arrangements, including identification, terms, features, collateral requirements and other information necessary to a fair presentation. These are debt arrangements that originally required repayment more than twelve months after issuance or greater than the normal operating cycle of the entity, if longer.

+ References

Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 210
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.5-02.22)
-URI http://asc.fasb.org/extlink&oid=6877327&loc=d3e13212-122682

Reference 2: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 1A
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28541-108399

Reference 3: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 6
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21506-112644

Reference 4: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 235
-SubTopic 10
-Section S99
-Paragraph 1
-Subparagraph (SX 210.4-08.(e),(f))
-URI http://asc.fasb.org/extlink&oid=26873400&loc=d3e23780-122690

Reference 5: http://fasb.org/us-gaap/role/ref/legacyRef
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-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 45
-Paragraph 2
-URI http://asc.fasb.org/extlink&oid=114775744&loc=d3e28551-108399

Reference 6: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 7
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21521-112644

Reference 7: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21538-112644

Reference 8: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 942
-SubTopic 470
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=75038535&loc=d3e64711-112823

Reference 9: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 835
-SubTopic 30
-Section 55
-Paragraph 8
-URI http://asc.fasb.org/extlink&oid=114775985&loc=d3e28878-108400

Reference 10: http://fasb.org/us-gaap/role/ref/legacyRef
-Publisher FASB
-Name Accounting Standards Codification
-Topic 505
-SubTopic 10
-Section 50
-Paragraph 3
-URI http://asc.fasb.org/extlink&oid=109259400&loc=d3e21475-112644

+ Details

Stock-based Compensation (Tables)

3 Months Ended

Mar. 31, 2020

Equity [Abstract]

Schedule of Stock-based Compensation Expense

Stock-based compensation expense included in the Company’s condensed consolidated statements of comprehensive loss is allocated as follows (in thousands):



	Three Months Ended March 31,
	2020		2019
Research and development	$	786	$	221
General and administrative	1,741		645
Sales and marketing	1,395		276
	$	3,922	$	1,142

Schedule of Option Awards Fair Valuation Assumptions



	Three Months Ended March 31,
	2020	2019
Expected term (in years)	6.05	5.50 - 6.16
Stock volatility	72.01%	70.81%
Risk-free interest rate	1.37%	2.26% - 2.56%
Dividend rate	—	—

Schedule of Stock Option Activity

The following table summarizes stock option activity under the 2014 and 2018 Plans (in thousands, except share and per share data):



	Number of Options		Weighted-Average Exercise Price Per Share		Aggregate Intrinsic Value
Outstanding at December 31, 2019	2,847,101		$	13.22
Options granted	5,000		29.03
Options exercised	(181,456	)	1.90		$	5,114	⁽¹⁾
Options forfeited	(9,261	)	22.62
Outstanding at March 31, 2020	2,661,384		$	13.99	$	33,358	⁽²⁾

_____________________________________________


(1)	Represents the total difference between the Company’s closing stock price at the time of exercise and the stock option exercise price, multiplied by the number of options exercised.


(2)	Represents the total difference between the Company’s closing stock price on the last trading day of the first quarter of 2020 and the stock option exercise price, multiplied by the number of in-the-money options as of March 31, 2020. The amount of intrinsic value will change based on the fair market value of the Company’s stock.

Schedule of Restricted Shares Awards Activity

The following table summarizes restricted shares awards activity:



	Number of Restricted Shares Awards		Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2019	586,166		$	23.59
Restricted shares awards granted	178,500		24.26
Restricted shares awards vested	(70,880	)	18.83
Restricted shares awards forfeited	(6,625	)	21.12
Outstanding at March 31, 2020	687,161		$	24.21

Schedule of Restricted Stock Units Activity

The following table summarizes restricted stock units activity:



	Number of Restricted Stock Units		Weighted-Average Fair Value Per Share at Grant Date
Outstanding at December 31, 2019	248,104		$	21.48
Restricted stock units granted	8,000		29.03
Restricted stock units vested	(46,336	)	$	14.19
Outstanding at March 31, 2020	209,768		$	23.37

Nature of Operations and Summary of Significant Accounting Policies - Narrative (Details) - USD ($)			3 Months Ended		12 Months Ended	87 Months Ended
	Nov. 22, 2019	Nov. 02, 2018	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2013	Mar. 31, 2020	Dec. 31, 2019
Investment Securities:
Unrealized gain (loss) on investment securities			$ 0	$ 0
Inventory:
Finished goods inventory			7,500,000			$ 7,500,000	$ 7,000,000
Work-in-process inventory			1,200,000			1,200,000	1,500,000
Raw materials inventory			10,500,000			10,500,000	7,200,000
Inventory reserves			100,000			100,000	100,000
Intangible Asset:
Finite-lived intangible asset acquired					$ 1,000,000
Finite-lived intangible assets, weighted-average amortization period					8 years 8 months 16 days
Accumulated amortization on intangible assets			700,000			700,000	$ 700,000
Impairment of finite-lived intangible asset						$ 0
Impairment of Long-Lived Assets:
Impairment of long-lived assets			$ 0
Leases:
Weighted-average remaining lease terms for operating leases			7 years 7 months			7 years 7 months	7 years 10 months
Weighted-average discount rate on operating leases (as a percent)			6.90%			6.90%	7.25%
Stock-Based Compensation:
Requisite service period of recognition of compensation cost			4 years
Net Loss per Share of Common Stock:
Potentially dilutive weighted-average shares not included in computation of diluted weighted average shares (in shares)			2,288,736	1,406,062
Minimum
Inventory:
Inventory shelf life			12 months
Property and Equipment:
Property and equipment useful life			3 years
Maximum
Inventory:
Inventory shelf life			27 months
Property and Equipment:
Property and equipment useful life			7 years
IPO
Initial Public Offering:
Stock issued (shares)		9,200,000
Sale of stock, price per share (USD per share)		$ 15
Net proceeds from sale of stock		$ 126,000,000
Exercise of Underwriters Option
Initial Public Offering:
Stock issued (shares)	750,000	1,200,000
Follow-on Offering
Initial Public Offering:
Stock issued (shares)	5,345,000
Sale of stock, price per share (USD per share)	$ 22
Net proceeds from sale of stock	$ 110,400,000
Common Stock
Initial Public Offering:
Conversion of preferred stock to common stock (shares)		15,813,297
Number of common stock warrants converted from preferred stock warrants (shares)		80,000
Preferred Stock
Intangible Asset:
Shares issued for purchase of intangible asset					50,000
Fair value of shares issued for purchase of intangible asset					$ 1,000,000.0
Stock Option and Restricted Stock-Based Awards
Stock-Based Compensation:
Vesting period			4 years
Restricted Stock Units
Stock-Based Compensation:
Vesting period			1 year

Nature of Operations and Summary of Significant Accounting Policies - Revenue Disaggregated by Geographic Market (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Disaggregation of Revenue [Line Items]
Net revenue	$ 26,296	$ 1,077
United States
Disaggregation of Revenue [Line Items]
Net revenue	25,046	0
International markets
Disaggregation of Revenue [Line Items]
Net revenue	$ 1,250	$ 1,077

Nature of Operations and Summary of Significant Accounting Policies - Fair Value Hierarchy (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	$ 0	$ 12,592
Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	5,397
Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	7,195
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
Commercial paper
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	7,195
Commercial paper \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
Commercial paper \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	7,195
Commercial paper \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
Corporate notes
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	2,018
Corporate notes \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	2,018
Corporate notes \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
Corporate notes \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
U.S. government and agency securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	3,379
U.S. government and agency securities \| Level 1
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	3,379
U.S. government and agency securities \| Level 2
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	0	0
U.S. government and agency securities \| Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments	$ 0	$ 0

Property and Equipment - Summary (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 8,818	$ 6,107
Less: accumulated depreciation and amortization	(3,412)	(3,060)
Property and equipment, net	5,406	3,047
Research and development equipment
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,176	1,086
Computer hardware and software
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,621	1,418
Tools and molds
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,305	1,303
Leasehold improvements
Property, Plant and Equipment [Line Items]
Property and equipment, gross	3,506	1,500
Furniture and fixtures
Property, Plant and Equipment [Line Items]
Property and equipment, gross	1,152	624
Construction in progress
Property, Plant and Equipment [Line Items]
Property and equipment, gross	$ 58	$ 176

Property and Equipment - Narrative (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Property, Plant and Equipment [Line Items]
Depreciation and amortization expense	$ 380	$ 276
Property and Equipment
Property, Plant and Equipment [Line Items]
Depreciation and amortization expense	$ 400	$ 200

Commitments and Contingencies - Narrative (Details)	3 Months Ended
Commitments and Contingencies - Narrative (Details)	Mar. 31, 2020 USD ($)	Mar. 31, 2019 USD ($)	Dec. 31, 2019 USD ($)	Jun. 30, 2019 ft²	Nov. 30, 2017 ft²	Aug. 31, 2014 ft²
Loss Contingencies [Line Items]
Right-of-use assets obtained in exchange for operating lease liabilities	$ 3,000,000	$ 0
Right-of-use asset	7,000,000		$ 4,200,000
Cash paid for operating lease liabilities	300,000	200,000
Amortization of the ROU asset	$ 200,000	100,000
Weighted-average remaining lease terms for operating leases	7 years 7 months		7 years 10 months
Weighted-average discount rate on operating leases (as a percent)	6.90%		7.25%
Period after first sale royalty is due	12 years
Net revenue due as royalty (as a percent)	4.00%
Revenues	$ 26,296,000	1,077,000
Royalty expense	1,000,000	$ 0
Maximum
Loss Contingencies [Line Items]
Royalty commitments	$ 200,000
First Lease
Loss Contingencies [Line Items]
Term of operating lease contract						5 years
Net rentable area (square feet) \| ft²						12,215
Second Lease
Loss Contingencies [Line Items]
Term of operating lease contract					7 years
Net rentable area (square feet) \| ft²					25,548
Renewal term of operating lease					5 years
Third Lease
Loss Contingencies [Line Items]
Term of operating lease contract				8 years
Net rentable area (square feet) \| ft²				32,621
Renewal term of operating lease				5 years

Commitments and Contingencies - Total Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Operating lease cost	$ 491	$ 240
Short-term lease cost	39	55
Variable lease cost	23	13
Total lease cost	$ 553	$ 308

Long-Term Debt - Narrative (Details)	3 Months Ended
Long-Term Debt - Narrative (Details)	Mar. 31, 2020 USD ($)	Dec. 31, 2019 USD ($)	Oct. 31, 2018 USD ($)	Feb. 28, 2018 USD ($) tranche
Debt Instrument [Line Items]
Face amount of debt instrument	$ 20,000,000	$ 20,000,000
Voting capital stock of foreign subsidiaries excluded from first priority lien (more than) (as a percent)	65.00%
Term Loans \| Term Loan
Debt Instrument [Line Items]
Long-term debt issuable				$ 20,000,000
Number of tranches \| tranche				3
Maximum prepayments of amounts outstanding allowed	$ 5,000,000
Period of prior written notice before prepayment of amounts outstanding	30 days
Final payment fee (as a percent)	7.50%
Term Loans \| Term Loan \| Period One
Debt Instrument [Line Items]
Prepayment fee (as a percent)	3.00%
Term Loans \| Term Loan \| Period Two
Debt Instrument [Line Items]
Prepayment fee (as a percent)	2.00%
Term Loans \| Term Loan \| Period Three
Debt Instrument [Line Items]
Prepayment fee (as a percent)	1.00%
Term Loans \| Term Loan \| Prime Rate
Debt Instrument [Line Items]
Basis spread on variable rate (as a percent)	1.75%
Term Loans \| Term Loan - Tranche A
Debt Instrument [Line Items]
Face amount of debt instrument				$ 10,000,000
Term Loans \| Term Loan - Tranche B & C
Debt Instrument [Line Items]
Face amount of debt instrument			$ 10,000,000
Term Loans \| Term Loan - Tranche B
Debt Instrument [Line Items]
Long-term debt issuable				5,000,000
Face amount of debt instrument			5,000,000
Term Loans \| Term Loan - Tranche C
Debt Instrument [Line Items]
Long-term debt issuable				5,000,000
Face amount of debt instrument			$ 5,000,000
Minimum gross proceeds from sale of equity securities				$ 20,000,000.0
Term Loans \| Second Amendment to the Loan Agreement
Debt Instrument [Line Items]
Non-refundable fee		$ 200,000

Long-Term Debt - Debt, Net of Unamortized Debt Issuance Costs (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Disclosure [Abstract]
Debt, principal	$ 20,000	$ 20,000
Accrued loan fees	1,500	1,500
Debt, total	21,500	21,500
Less: unamortized debt issuance costs	(929)	(1,164)
Debt, net of unamortized debt issuance costs	20,571	20,336
Less: debt, current portion	(5,000)	0
Debt, net of unamortized debt issuance costs, net of current portion	$ 15,571	$ 20,336

Stock-based Compensation - Summary (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 3,922	$ 1,142
Research and development
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	786	221
General and administrative
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	1,741	645
Sales and marketing
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Share-based compensation expense	$ 1,395	$ 276

Stock-based Compensation - Fair Value Assumptions (Details)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)	6 years 18 days
Stock volatility, minimum (as a percent)	72.01%	70.81%
Stock volatility, maximum (as a percent)	72.01%	70.81%
Risk-free interest rate, minimum (as a percent)	1.37%	2.26%
Risk-free interest rate, maximum (as a percent)	1.37%	2.56%
Dividend rate (as a percent)	0.00%	0.00%
Minimum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)		5 years 6 months
Maximum
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Expected term (in years)		6 years 1 month 29 days

Stock-based Compensation - Narrative (Details) - USD ($) $ / shares in Units, $ in Millions			3 Months Ended		12 Months Ended
	Jul. 16, 2019	May 29, 2019	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average grant date fair value of options granted			$ 18.56	$ 10.69
Stock Option
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Unrecognized compensation cost related to unvested stock options			$ 17.6		$ 19.5
Weighted-average period of recognition of compensation cost			3 years 1 month		3 years 2 months
Weighted-average remaining contractual term of options outstanding and exercisable			7 years 9 months		7 years 7 months
Restricted Shares Awards
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average period of recognition of compensation cost			3 years 6 months		3 years 3 months
Unrecognized compensation cost related to unvested RSAs or RSUs			$ 14.9		$ 11.8
Restricted Stock Units
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Weighted-average period of recognition of compensation cost			1 year 3 months		1 year 6 months
Unrecognized compensation cost related to unvested RSAs or RSUs			$ 3.6		$ 4.3
Warrants
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Stock issued upon exercise of warrants (shares)	32,529	31,071
Number of warrants exercised (shares)	40,000	40,000
Exercise price of warrants (USD per share)	$ 7.50	$ 7.50
Warrants outstanding (shares)			0

Stock-based Compensation - Stock Option Activity (Details) - Stock Option $ / shares in Units, $ in Thousands	3 Months Ended
	Mar. 31, 2020 USD ($) $ / shares shares
Number of Options
Outstanding at beginning of period (shares) \| shares	2,847,101
Options granted (shares) \| shares	5,000
Options exercised (shares) \| shares	(181,456)
Options forfeited (shares) \| shares	(9,261)
Outstanding at end of period (shares) \| shares	2,661,384
Weighted-Average Exercise Price Per Share
Outstanding at beginning of period (USD per share) \| $ / shares	$ 13.22
Options granted (USD per share) \| $ / shares	29.03
Options exercised (USD per share) \| $ / shares	1.90
Options forfeited (USD per share) \| $ / shares	22.62
Outstanding at end of period (USD per share) \| $ / shares	$ 13.99
Aggregate Intrinsic Value
Intrinsic value of options exercised \| $	$ 5,114
Intrinsic value of options outstanding \| $	$ 33,358

Stock-based Compensation - Restricted Shares Awards Activity (Details) - Restricted Shares Awards	3 Months Ended
	Mar. 31, 2020 $ / shares shares
Number of Restricted Shares Awards
Outstanding at beginning of period (shares) \| shares	586,166
Granted (shares) \| shares	178,500
Vested (shares) \| shares	(70,880)
Forfeited (shares) \| shares	(6,625)
Outstanding at end of period (shares) \| shares	687,161
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (USD per share) \| $ / shares	$ 23.59
Granted (USD per share) \| $ / shares	24.26
Vested (USD per share) \| $ / shares	18.83
Forfeited (USD per share) \| $ / shares	21.12
Outstanding at end of period (USD per share) \| $ / shares	$ 24.21

Stock-based Compensation - Restricted Stock Units Activity (Details) - Restricted Stock Units	3 Months Ended
	Mar. 31, 2020 $ / shares shares
Number of Restricted Stock Units
Outstanding at beginning of period (shares) \| shares	248,104
Granted (shares) \| shares	8,000
Vested (shares) \| shares	(46,336)
Outstanding at end of period (shares) \| shares	209,768
Weighted-Average Fair Value Per Share at Grant Date
Outstanding at beginning of period (USD per share) \| $ / shares	$ 21.48
Granted (USD per share) \| $ / shares	29.03
Vested (USD per share) \| $ / shares	14.19
Outstanding at end of period (USD per share) \| $ / shares	$ 23.37

Income Taxes - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
Income Taxes - Narrative (Details) - USD ($) $ in Millions	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Income Tax Contingency [Line Items]
Annual effective tax rate (as a percent)	0.00%	0.00%
Operating loss carryforwards			$ 162.5
Research Tax Credit Carryforward
Income Tax Contingency [Line Items]
Tax credit carryforwards			2.0
Research Tax Credit Carryforward \| Prepaid Expenses and Other Current Assets
Income Tax Contingency [Line Items]
Tax credit carryforwards	$ 0.9		$ 0.9

Employee Benefit Plan - Narrative (Details) - USD ($) $ in Millions	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Retirement Benefits [Abstract]
Contributions by employer	$ 0.4	$ 0.1

Related Party Transactions - Narrative (Details) - USD ($)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Scientific Advisory
Related Party Transaction [Line Items]
Expenses from transactions with related parties	$ 0	$ 0
Accounts payable to related parties	0		$ 0
Engineering and Design Services
Related Party Transaction [Line Items]
Expenses from transactions with related parties	0	$ 100,000
Accounts payable to related parties	$ 0		$ 0