Conformis (CFMS) 10-Q 4 Nov 20 2020 Q3 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	9 Months Ended
	Sep. 30, 2020	Oct. 31, 2020
Document and Entity Information
Entity Registrant Name	CONFORMIS INC
Entity Central Index Key	0001305773
Current Fiscal Year End Date	--12-31
Entity Filer Category	Non-accelerated Filer
Entity Emerging Growth Company	true
Entity Ex Transition Period	true
Entity Small Business	true
Entity Shell Company	false
Document Type	10-Q
Document Period End Date	Sep. 30, 2020
Document Fiscal Year Focus	2020
Document Fiscal Period Focus	Q3
Amendment Flag	false
Entity Common Stock, Shares Outstanding		85,940,699
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes

Consolidated Balance Sheets

Consolidated Balance Sheets - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Current Assets
Cash and cash equivalents	$ 32,888	$ 26,394
Accounts receivable, net	8,980	11,066
Royalty and licensing receivable	3,751	165
Inventories, net	12,909	12,074
Prepaid expenses and other current assets	2,800	2,815
Total current assets	61,328	52,514
Property and equipment, net	13,065	13,356
Operating lease right-of-use assets	4,977	5,853
Other Assets
Restricted cash	462	462
Other long-term assets	179	211
Total assets	80,011	72,396
Current liabilities
Accounts payable	5,414	6,920
Accrued expenses	7,722	7,135
Operating lease liabilities	1,498	1,469
Advance on research and development	3,636	2,331
Contract liability	14,000	0
Total current liabilities	32,270	17,855
Other long-term liabilities	0	1,500
Contract liability	0	12,000
Long-term debt, less debt issuance costs	24,833	19,623
Operating lease liabilities	4,103	5,071
Total liabilities	61,206	56,049
Commitments and contingencies
Stockholders’ equity
Preferred stock, $0.00001 par value: Authorized: 5,000,000 shares authorized as of June 30, 2020 and December 31, 2019; no shares issued and outstanding as of June 30, 2020 and December 31, 2019	0	0
Common stock, $0.00001 par value: Authorized: 200,000,000 shares authorized as of June 30, 2020 and December 31, 2019; 75,973,605 and 70,427,400 shares issued and outstanding as of June 30, 2020 and December 31, 2019, respectively	1	1
Additional paid-in capital	542,986	521,356
Accumulated deficit	(521,816)	(504,145)
Accumulated other comprehensive loss	(2,366)	(865)
Total stockholders’ equity	18,805	16,347
Total liabilities and stockholders’ equity	$ 80,011	$ 72,396

Consolidated Balance Sheets (Pa

Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.00001	$ 0.00001
Preferred stock, shares authorized	5,000,000	5,000,000
Preferred stock, shares issued	0	0
Preferred stock, shares outstanding	0	0
Common stock, par value (in dollars per share)	$ 0.00001	$ 0.00001
Common stock, shares authorized	200,000,000	200,000,000
Common stock, shares issued	86,173,070	70,427,400
Common stock, shares outstanding	86,173,070	70,427,400

Consolidated Statements of Oper

Consolidated Statements of Operations (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Revenue
Total revenue	$ 16,121	$ 17,303	$ 52,064	$ 57,540
Cost of revenue	8,437	9,675	26,148	30,459
Gross profit	7,684	7,628	25,916	27,081
Operating expenses
Sales and marketing	5,755	6,153	16,420	21,231
Research and development	2,866	3,162	8,594	9,402
General and administrative	6,134	5,165	18,344	15,783
Total operating expenses	14,755	14,480	43,358	46,416
Loss from operations	(7,071)	(6,852)	(17,442)	(19,335)
Other income and expenses
Interest income	8	58	66	256
Interest expense	(611)	(573)	(1,769)	(2,363)
Foreign currency exchange transaction income (loss)	1,511	(1,313)	1,491	(1,568)
Total other income (expenses)	908	(1,828)	(212)	(3,675)
Loss before income taxes	(6,163)	(8,680)	(17,654)	(23,010)
Income tax provision	20	21	17	35
Net loss	$ (6,183)	$ (8,701)	$ (17,671)	$ (23,045)
Net loss per share - basic and diluted (in dollars per share)	$ (0.09)	$ (0.13)	$ (0.25)	$ (0.36)
Weighted average common shares outstanding - basic and diluted (in shares)	71,224,786	64,750,275	69,799,495	63,651,412
Product
Revenue
Total revenue	$ 15,975	$ 17,112	$ 42,008	$ 56,918
Royalty and licensing
Revenue
Total revenue	$ 146	$ 191	$ 10,056	$ 622

Consolidated Statements of Comp

Consolidated Statements of Comprehensive Loss (unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Statement of Comprehensive Income [Abstract]
Net loss	$ (6,183)	$ (8,701)	$ (17,671)	$ (23,045)
Other comprehensive (loss) income
Foreign currency translation adjustments	(1,450)	1,227	(1,501)	1,445
Comprehensive loss	$ (7,633)	$ (7,474)	$ (19,172)	$ (21,600)

Consolidated Statements of Chan

Consolidated Statements of Changes in Stockholder's Equity - USD ($) $ in Thousands	Total	Common Stock	Additional Paid-In Capital	Accumulated Deficit	Accumulated other comprehensive income (loss)	LPC Offering	LPC OfferingCommon Stock	LPC OfferingAdditional Paid-In Capital	At The Market Offering	At The Market OfferingCommon Stock	At The Market OfferingAdditional Paid-In Capital	Registered Direct Offering	Registered Direct OfferingCommon Stock	Registered Direct OfferingAdditional Paid-In Capital
Beginning balance (in shares) at Dec. 31, 2018		65,290,879
Beginning balance at Dec. 31, 2018	$ 36,200	$ 1	$ 513,336	$ (475,667)	$ (1,470)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		2,278,322
Issuance of common stock--option exercise (in shares)		34,669
Issuance of common stock—option exercise	121		121
Issuance of common stock (in shares)		775,194
Issuance of common stock	3,000		3,000
Compensation expense related to issued stock options and restricted stock awards	2,179		2,179
Net loss	(23,045)			(23,045)
Other comprehensive income (loss)	1,445				1,445
Ending balance (in shares) at Sep. 30, 2019		68,379,064
Ending balance at Sep. 30, 2019	19,900	$ 1	518,636	(498,712)	(25)
Beginning balance (in shares) at Jun. 30, 2019		68,689,192
Beginning balance at Jun. 30, 2019	27,301	$ 1	518,563	(490,011)	(1,252)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		(310,128)
Compensation expense related to issued stock options and restricted stock awards	73		73
Net loss	(8,701)			(8,701)
Other comprehensive income (loss)	1,227				1,227
Ending balance (in shares) at Sep. 30, 2019		68,379,064
Ending balance at Sep. 30, 2019	$ 19,900	$ 1	518,636	(498,712)	(25)
Beginning balance (in shares) at Dec. 31, 2019	70,427,400	70,427,400
Beginning balance at Dec. 31, 2019	$ 16,347	$ 1	521,356	(504,145)	(865)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		3,840,651
Issuance of common stock—restricted stock	2
Issuance of common stock (in shares)							2,600,000			792,931
Issuance of common stock						$ 2,403		$ 2,403	$ 746		$ 746
Issuance of common stock and pre-funded warrants under registered direct offering, less issuance costs (in shares)													8,512,088
Issuance of common stock and pre-funded warrants under registered direct offering, less issuance costs												$ 15,896		$ 15,896
Compensation expense related to issued stock options and restricted stock awards	2,583		2,583
Net loss	(17,671)
Other comprehensive income (loss)	$ (1,501)				(1,501)
Ending balance (in shares) at Sep. 30, 2020	86,173,070	86,173,070
Ending balance at Sep. 30, 2020	$ 18,805	$ 1	542,986	(521,816)	(2,366)
Beginning balance (in shares) at Jun. 30, 2020		76,103,605
Beginning balance at Jun. 30, 2020	8,443	$ 1	524,991	(515,633)	(916)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Issuance of common stock—restricted stock (in shares)		104,489
Issuance of common stock—restricted stock	0
Issuance of common stock (in shares)							1,400,000			52,888
Issuance of common stock						$ 1,086		$ 1,086	$ 41		$ 41
Issuance of common stock and pre-funded warrants under registered direct offering, less issuance costs (in shares)													8,512,088
Issuance of common stock and pre-funded warrants under registered direct offering, less issuance costs												$ 15,896		$ 15,896
Compensation expense related to issued stock options and restricted stock awards	972		972
Net loss	(6,183)
Other comprehensive income (loss)	$ (1,450)				(1,450)
Ending balance (in shares) at Sep. 30, 2020	86,173,070	86,173,070
Ending balance at Sep. 30, 2020	$ 18,805	$ 1	$ 542,986	$ (521,816)	$ (2,366)

Consolidated Statements of Cash

Consolidated Statements of Cash Flows - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019
Cash flows from operating activities:
Net loss	$ (17,671)	$ (23,045)
Adjustments to reconcile net loss to net cash (used in) provided by operating activities:
Depreciation and amortization expense	3,292	3,192
Stock-based compensation expense	2,583	2,179
Unrealized foreign exchange loss	(1,513)	1,506
Non-cash lease expense	875	863
Provision for bad debts on trade receivables	72	58
Impairment of long-term assets	0	60
Loss on extinguishment of debt	0	1,085
Non-cash interest expense	531	225
Changes in operating assets and liabilities:
Accounts receivable	2,015	2,708
Royalty and licensing receivable	(3,586)	(25)
Inventories	(836)	(2,023)
Prepaid expenses and other assets	16	(254)
Accounts payable, accrued expenses and other liabilities	(3,358)	976
Contract liability	2,000	11,500
Advance on research and development	1,305	2,500
Net cash (used in) provided by operating activities	(14,275)	1,501
Cash flows from investing activities:
Acquisition of property and equipment	(3,001)	(2,102)
Maturity of investments	0	7,250
Net cash (used in) provided by investing activities	(3,001)	5,148
Cash flows from financing activities:
Proceeds from exercise of common stock options	0	121
Debt issuance costs	(10)	(737)
Loss on extinguishment of debt	0	(919)
Proceeds from issuance of debt	4,720	20,000
Amortization/accretion on investments	0	(4)
Payments on long-term debt	0	(15,000)
Net proceeds from issuance of common stock	3,151	3,000
Issuance of common stock and pre-funded warrants under registered direct offering, net	(15,896)	0
Net cash provided by financing activities	23,757	6,465
Foreign exchange effect on cash and cash equivalents	13	(61)
Increase in cash, cash equivalents and restricted cash	6,494	13,053
Cash, cash equivalents and restricted cash beginning of period	26,856	16,842
Cash, cash equivalents and restricted cash end of period	33,350
Supplemental information:
Cash paid for interest	1,056	1,772
Non cash investing and financing activities:
Operating leases right-of-use assets obtained in exchange for lease obligations	$ 0	$ 6,988

Organization and Basis of Prese

Organization and Basis of Presentation	9 Months Ended
	Sep. 30, 2020
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Organization and Basis of Presentation	Organization and Basis of Presentation Conformis, Inc. (together with its subsidiaries, collectively, the “Company”) is a medical technology company that uses its proprietary iFit Image-to-Implant technology platform to develop, manufacture and sell joint replacement implants that are individually sized and shaped, which the Company refers to as personalized, individualized, or sometimes as customized, to fit and conform to each patient’s unique anatomy. The Company offers a broad line of sterile, personalized knee and hip implants and single-use instruments delivered to hospitals. The Company’s proprietary iFit technology platform is potentially applicable to all major joints. The Company was incorporated in Delaware and commenced operations in 2004. The Company introduced its iUni and iDuo in 2007, its iTotal CR in 2011, its iTotal PS in 2015, and its Conformis Hip System in 2018. The Company has its corporate offices in Billerica, Massachusetts. These consolidated financial statements as of September 30, 2020 and for the three and nine months ended September 30, 2020 and 2019 , and related interim information contained within the notes to the Consolidated Financial Statements, have been prepared assuming that the Company will continue as a going concern, which contemplates the realization of assets and satisfaction of liabilities in the normal course of business. Liquidity and operations Since the Company’s inception in June 2004, it has financed its operations primarily through private placements of preferred stock, its initial public offering in July 2015, other equity financings, debt and convertible debt financings, equipment purchase loans, patent licensing, and product revenue beginning in 2007. The Company has not yet attained profitability and continues to incur operating losses and negative operating cash flows, which adversely impacts the Company's ability to continue as a going concern. At September 30, 2020 , the Company had an accumulated deficit of $521.8 million and cash and cash equivalents of $32.9 million , and $0.5 million in restricted cash allocated to lease deposits. In December 2019, a human infection originating in China was traced to a novel strain of coronavirus. The virus subsequently spread to other parts of the world, including the United States and Europe, and caused unprecedented disruptions in the global economy as efforts to contain the spread of the virus intensified. In March 2020, the World Health Organization declared this coronavirus outbreak (COVID-19) to be a pandemic. The future progression of the pandemic, including the scope, severity and duration of the pandemic, potential resurgences, the speed and effectiveness of vaccine and treatment developments, and the direct and indirect economic effects of the pandemic and containment measures, and its effects on the Company's business and operations remain highly uncertain. The Company has experienced significantly decreased demand for its products during the pandemic as healthcare providers and individuals have de-prioritized and deferred medical procedures deemed to be elective, such as joint replacement procedures, which has had and is expected to continue to have a significant negative effect on the Company's revenue. Uncertainties related to the COVID-19 pandemic, the timing of completion of the remaining milestones set forth in the Stryker Agreement, and the Company's ability to raise capital raise substantial doubt about the Company's ability to continue as a going concern. The Company’s consolidated financial statements have been prepared assuming that the Company will continue as a going concern, which contemplates the realization of assets and the settlement of liabilities and commitments in the normal course of business. The financial statements do not include any adjustments that might be necessary if the Company is unable to continue as a going concern. The Company may need to engage in additional equity or debt financings to secure additional funds. The Company may not be able to obtain additional financing on terms favorable to it, or at all. To the extent that the Company raises additional capital through the future sale of equity or debt, the ownership interests of its existing stockholders will be diluted. The terms of these future equity or debt securities may include liquidation or other preferences that adversely affect the rights of the Company's existing common stockholders or involve negative covenants that restrict the Company's ability to take specific actions, such as incurring additional debt or making capital expenditures. On September 23, 2020, the Company and a healthcare-focused institutional investor entered into a subscription agreement (the "Subscription Agreement"), pursuant to which the Company sold (i) 8,512,088 shares of its common stock and accompanying warrants to purchase up to 8,512,088 shares of common stock and (ii) pre-funded warrants to purchase up to 9,492,953 shares of common stock and accompanying warrants to purchase up to 9,492,953 shares of common stock in a registered direct offering for gross proceeds of approximately $17.3 million . The common stock (or pre-funded warrants in lieu thereof) and accompanying warrants were sold as units, each consisting of one share (or one pre-funded warrant to purchase one share of common stock in lieu thereof) and one warrant to purchase one share of common stock, at an offering price of $0.9581 per unit. The pre-funded warrants became exercisable immediately upon issuance, have an exercise price of $0.0001 per share and will be exercisable until all of the pre-funded warrants are exercised in full. The warrants became exercisable immediately upon issuance, have an exercise price of $0.8748 per share, and will expire five years from the date of issuance. The pre-funded warrants and the warrants each prohibit the holder from exercising any portion thereof to the extent that the holder would own more than 9.99% of the number of shares of common stock outstanding immediately after exercise. The number of shares issuable upon exercise of the warrants and pre-funded warrants and the exercise price of the warrants and pre-funded warrants is adjustable in the event of stock splits, stock dividends, combinations of shares and similar recapitalization transactions. The net proceeds to the Company from the offering, after deducting the placement agent's fees and other estimated offering expenses payable by the Company, was approximately $15.9 million . For further information regarding the registered direct offering, see “Note J—Stockholders' Equity” in the financial statements and related notes appearing elsewhere in this Quarterly Report on Form 10-Q. In January 2017, the Company filed a shelf registration statement on Form S-3, which was declared effective by the Securities and Exchange Commission ("SEC") on May 9, 2017 (the "2017 Shelf Registration Statement"). The 2017 Shelf Registration Statement allowed the Company to sell from time to time up to $200 million of common stock, preferred stock, debt securities, warrants, or units comprised of any combination of these securities, for its own account in one or more offerings. On May 10, 2017, the Company filed with the SEC a prospectus supplement, for the sale and issuance of up to $50 million of its common stock and entered into an Equity Distribution Agreement (“Distribution Agreement”) with Canaccord Genuity LLC (formerly, Canaccord Genuity Inc.) ("Canaccord") pursuant to which Canaccord agreed to sell shares of the Company's common stock from time to time, as its agent, in an “at-the-market” ("ATM") offering as defined in Rule 415 promulgated under the U.S. Securities Act of 1933, as amended (the "Securities Act"). The Company was not obligated to sell any shares under the Distribution Agreement. On August 4, 2020, the Company and Canaccord mutually agreed to terminate the Distribution Agreement and as of that date, the Company had sold 2,663,000 shares under the Distribution Agreement resulting in net proceeds of $4.4 million . On March 23, 2020, the Company filed a new shelf registration statement on Form S-3 (the "New Shelf Registration Statement"), which was declared effective by the SEC on August 5, 2020. Under the New Shelf Registration Statement, the Company is permitted to sell from time to time up to $200 million of common stock, preferred stock, debt securities, warrants, or units comprised of any combination of these securities, for its own account in one or more offerings. On August 5, 2020, the Company filed with the SEC a prospectus supplement, for the sale and issuance of up to $25 million of its common stock and entered into a sales agreement (the “Sales Agreement”) with Cowen and Company, LLC (“Cowen”) pursuant to which the Company may offer and sell shares of the Company’s common stock to or through Cowen, acting as agent and/or principal, from time to time, in an “at-the-market” offering as defined in Rule 415 promulgated under the Securities Act, including without limitation sales made by means of ordinary brokers’ transactions on the Nasdaq Global Select Market or otherwise at market prices prevailing at the time of sale, in block transactions, or as otherwise directed by the Company. Cowen will use commercially reasonable efforts to sell the Common Stock from time to time, based upon instructions from the Company (including any price, time or size limits or other customary parameters or conditions the Company may impose). The Company will pay Cowen a commission of up to 3.0% of the gross sales proceeds of any Common Stock sold through Cowen under the Sales Agreement, and also has provided Cowen with customary indemnification rights. The shares of Common Stock being offered pursuant to the Sales Agreement will be offered and sold pursuant to the New Shelf Registration Statement. The Company is not obligated to make any sales of Common Stock under the Sales Agreement. The offering of shares of Common Stock pursuant to the Sales Agreement will terminate upon the earlier of (i) the sale of all Common Stock subject to the Sales Agreement or (ii) termination of the Sales Agreement in accordance with its terms. As of September 30, 2020 , the Company had not sold any shares under the Sales Agreement. On December 17, 2018, the Company entered into a stock purchase agreement (the "Stock Purchase Agreement") with Lincoln Park Capital ("LPC"). Upon entering into the Stock Purchase Agreement, the Company sold 1,921,968 shares of common stock for $1.0 million to LPC, representing a premium of 110% to the previous day's closing price. As consideration for LPC’s commitment to purchase shares of common stock under the Stock Purchase Agreement, the Company issued 354,430 shares to LPC. The Company has the right at its sole discretion to sell to LPC up to $20.0 million worth of shares over a 36 -month period subject to the terms of the Stock Purchase Agreement. The Company controls the timing of any sales to LPC and LPC will be obligated to make purchases of the Company's common stock upon receipt of requests from the Company in accordance with the terms of the Stock Purchase Agreement. There are no upper limits to the price per share LPC may pay to purchase up to $20.0 million worth of common stock subject to the Stock Purchase Agreement, and the purchase price of the shares will be based on the then prevailing market prices of the Company's shares at the time of each sale to LPC as described in the Stock Purchase Agreement, provided that LPC will not be obligated to make purchases of the Company's common stock pursuant to receipt of a request from the Company on any business day on which the last closing trade price of the Company's common stock on the Nasdaq Capital Market (or alternative national exchange in accordance with the Stock Purchase Agreement) is below a floor price of $0.25 per share. No warrants, derivatives, financial or business covenants are associated with the Stock Purchase Agreement and LPC has agreed not to cause or engage in any manner whatsoever, any direct or indirect short selling or hedging of shares of the Company's common stock. The Stock Purchase Agreement may be terminated by the Company at any time, at the Company's sole discretion, without any cost or penalty. On August 5, 2020, the Company filed with the SEC a prospectus supplement, for the sale and issuance of up to $17.6 million of its common stock pursuant to the Stock Purchase Agreement dated December 17, 2018. As of September 30, 2020 , the Company had sold 4,521,968 shares under the Stock Purchase Agreement resulting in proceeds of $3.4 million . On June 25, 2019, the Company entered into a Loan and Security Agreement (the "2019 Secured Loan Agreement") with Innovatus Life Sciences Lending Fund I, LP ("Innovatus"), as collateral agent and lender, East West Bank and the other lenders party thereto from time to time (collectively, the "Lenders"), pursuant to which the Lenders agreed to make term loans and revolving credit facility to the Company to repay existing indebtedness, for working capital and general business purposes, in a principal amount of up to $30 million . The Company used the proceeds from the debt financings to pay off its senior secured loan and security agreement (the "2017 Secured Loan Agreement") with Oxford Finance LLC ("Oxford"). In addition, Innovatus purchased approximately $3 million of the Company's common stock at the previous day's closing price (the "Private Placement"). During the first quarter of 2020, the Company reported that it may not be able to meet its second quarter revenue covenant and would work with Innovatus with the goal of adjusting the revenue covenants under the 2019 Secured Loan Agreement. On July 1, 2020, the Company entered into a Third Amendment to its Loan and Security Agreement, dated as of June 25, 2019 (the "Amendment"). The Amendment, among other things, waives the trailing six-month revenue covenant milestones that apply to the quarters ending June 30, September 30 and December 31, 2020 under the Loan Agreement and reduces the revenue covenant milestones that apply thereafter, delays until June 25, 2021 the Company’s option to prepay all, but not less than all, of the term loans advanced under the Loan Agreement and includes a new covenant that the Company raise additional capital. The Amendment also increases the Company’s minimum cash covenant to $5 million until December 31, 2020. The capital raise covenant in the Amendment specifies that on or before December 31, 2020, the Company shall receive aggregate gross cash proceeds of not less than $20.0 million from (i) the sale and issuance of its equity securities (including, without limitation, by means of ATM offerings, private placements, follow on public offerings), (ii) net payments received from any of patent infringement disputes with Zimmer on or after July 1, 2020 and on or before December 31 2020, (iii) net payments received from any of its other patent infringement disputes with any other party not specified in clause (ii), (iv) monetization of R&D tax credits or NOLs as part of any current or future 2020 government stimulus packages, or (v) governmental grants that are not (in whole or in part) in the form of indebtedness, or any combination of two or more of the foregoing. As of September 30, 2020 , as a result of the proceeds received under the registered direct offering, the Company was able to satisfy the capital raise covenant. On August 20, 2020, the Company entered into a Fourth Amendment to its Loan and Security Agreement, dated as of June 25, 2019 (the "Fourth Amendment"). The Fourth Amendment, among other things, amends and waives certain provisions of the Loan Agreement that apply to the Conformis India entity, a copy of which is filed herewith as Exhibit 10.1. For further information regarding the 2017 Secured Loan Agreement, the 2019 Secured Loan Agreement and the Amendment, see “Note I—Debt and Notes Payable” in the financial statements and related notes appearing elsewhere in this Quarterly Report on Form 10-Q. On September 30, 2019, the Company entered into an Asset Purchase Agreement (the "Asset Purchase Agreement") with Howmedica Osteonics Corp., a subsidiary of Stryker Corporation also known as Stryker Orthopaedics ("Stryker"). In connection with entering into the Asset Purchase Agreement, the Company and Stryker also entered into a Development Agreement (the "Development Agreement"), a License Agreement (the "License Agreement"), a Distribution Agreement (the "Distribution Agreement" and, together with the Asset Purchase Agreement, the Development Agreement and the License Agreement (the "Stryker Agreements") and other ancillary agreements contemplated by the Stryker Agreements. Under the terms of the Stryker Agreements, the Company agreed to sell and license to Stryker certain assets relating to the Company's patient-specific instrumentation technology, and to develop, manufacture, and supply patient-specific instrumentation for use in connection with Stryker's "off-the-shelf" non-personalized knee implant offerings. The Company received $14 million upfront and became eligible to receive up to an additional $16 million in milestone payments pursuant to the License Agreement and the Development Agreement. As of September 30, 2020 , the Company had completed two of three milestones set forth in the License Agreement and the Development Agreement and received $5.0 million for achievement of these milestones. Under the long-term Distribution Agreement, the Company will supply patient specific instrumentation to Stryker. The Stryker Agreements contain termination provisions pursuant to which, under certain circumstances, Stryker may be able to terminate the Development Agreement and oblige the Company to repay a portion of the initial payment. In other circumstances, Stryker could terminate and pay an additional fee for the right to use the Company's intellectual property to sell patient-specific instrumentation with their off-the-shelf knee offering, subject to paying the Company a sales-based royalty fee. On May 22, 2020, the Company entered into a Settlement and License Agreement (the “Settlement and License Agreement”) with Zimmer Biomet, Zimmer US, Inc. and Biomet Manufacturing, LLC (collectively, “Zimmer Biomet”) as discussed in Note H—Commitments and Contingencies, Legal proceedings, which provided the Company with $9.6 million of royalty and licensing revenue for the quarter ended June 30, 2020. In consideration of the licenses, releases, covenants and other immunities granted by the Company to Zimmer Biomet, Zimmer Biomet was required to pay the Company $3.5 million promptly after execution of the Settlement and License Agreement, which it has, and additional payments on specified dates through January 15, 2021, for a total amount payable of $9.6 million . As of November 4, 2020, the Company had received total payments of $8.5 million . The Company funds its operations, capital expenditure requirements and debt service with existing cash and cash equivalents as of September 30, 2020 , and plans to address matters that raise substantial doubt about the Company's ability to continue as a going concern through anticipated revenue from operations, the successful completion of the milestones set forth in the Development Agreement and License Agreement, revenue that may be generated in connection with licensing its intellectual property, available sales of shares under the Sales Agreement and the Stock Purchase Agreement, and available borrowings under the revolving credit facility. In order for the Company to meet its operating plan, gross margin improvements and leveraging operating expenses will be necessary to reduce cash used in operations, and the Company will need to successfully complete the remaining milestone set forth in the Development Agreement and the License Agreement which cannot be assured. When the Company needs additional equity or debt financing proceeds to fund its operations, the Company may not be able to obtain additional financing on terms favorable to the Company, or at all. Basis of presentation and use of estimates The preparation of consolidated financial statements in conformity with generally accepted accounting principles in the United States ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements, and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates used in these consolidated financial statements include revenue recognition, accounts receivable valuation, inventory reserves, purchase accounting, impairment assessments, equity instruments, stock compensation, income tax reserves and related allowances, and the lives of property and equipment, and valuation of right-of-use lease assets and lease liabilities. Actual results may differ from those estimates. The interim financial statements should be read in conjunction with the audited financial statements and notes thereto included in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 . Unaudited Interim Financial Information The accompanying Interim Consolidated Financial Statements as of September 30, 2020 and for the three and nine months ended September 30, 2020 and 2019 , and related interim information contained within the notes to the Consolidated Financial Statements are unaudited. These unaudited interim consolidated financial statements have been prepared in accordance with GAAP. In management’s opinion, the unaudited interim consolidated financial statements have been prepared on the same basis as the audited financial statements and include all adjustments (including normal recurring adjustments) necessary for the fair presentation of the Company’s financial position as of September 30, 2020 , results of operations for and stockholders' equity for the three and nine months ended September 30, 2020 and 2019 , and comprehensive loss, and cash flows for the nine months ended September 30, 2020 and 2019 . The results for the three and nine months ended September 30, 2020 are not necessarily indicative of the results expected for the full year or any interim period.

Summary of Significant Accounti

Summary of Significant Accounting Policies	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Summary of Significant Accounting Policies	Summary of Significant Accounting Policies The Company's financial results are affected by the selection and application of accounting policies and methods. There were no material changes in the nine months ended September 30, 2020 to the application of significant accounting policies and estimates as described in its audited consolidated financial statements for the year ended December 31, 2019 . Concentrations of credit risk and other risks and uncertainties Financial instruments that subject the Company to credit risk primarily consist of cash, cash equivalents, and accounts receivable. The Company maintains the majority of its cash with accredited financial institutions. The Company and its contract manufacturers rely on sole source suppliers and service providers for certain components. There can be no assurance that a shortage or stoppage of shipments of the materials or components that the Company purchases will not result in a delay in production or adversely affect the Company’s business. On an ongoing basis, the Company validates alternate suppliers relative to certain key components as needed. For the three months ended September 30, 2020 , no customer represented greater than 10% of total revenue. For the nine months ended September 30, 2020 , Zimmer Biomet represented 18% of total revenue. For the three and nine months ended September 30, 2019 , no customer represented greater than 10% of total revenue. As of September 30, 2020 , payments due from Zimmer Biomet represented 40% of our total net receivable balance. As of December 31, 2019 , there were no customers that represented greater than 10% of the total net receivable balance. Principles of consolidation The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries: ImaTx, Inc.; ConforMIS Europe GmbH; ConforMIS UK Limited; ConforMIS Hong Kong Limited; and Conformis Cares LLC. All intercompany balances and transactions have been eliminated in consolidation. Cash, cash equivalents and restricted cash The Company considers all highly liquid investment instruments with original maturities of 90 days or less when purchased to be cash equivalents. The Company’s cash equivalents consist of demand deposits , money market accounts, money market funds, and repurchase agreements on deposit with certain financial institutions, in addition to cash deposits in excess of federally insured limits. Demand deposits and money market accounts are carried at cost which approximates their fair value. Money market funds are carried at fair value based upon level 1 inputs. Repurchase agreements are valued using level 2 inputs. The associated risk of concentration is mitigated by banking with credit worthy financial institutions. The Company had $1.1 million as of September 30, 2020 and $0.8 million as of December 31, 2019 held in foreign bank accounts that are not federally insured. In addition, the Company has recorded restricted cash of $0.5 million as of September 30, 2020 and December 31, 2019 . Restricted cash consisted of security provided for lease obligations. The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown in the consolidated statements of cash flows. September 30, December 31, Cash and cash equivalents $ 32,888 $ 26,394 Restricted cash 462 462 Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 33,350 $ 26,856 Fair value of financial instruments Certain of the Company’s financial instruments, including cash and cash equivalents (excluding money market funds), accounts receivable, accounts payable, accrued expenses and other liabilities are carried at cost, which approximates their fair value because of the short-term maturity. Based on borrowing rates currently available to the Company for loans with similar terms, the carrying value of the Company’s long-term debt approximates its fair value. Accounts receivable and allowance for doubtful accounts Accounts receivable consist of billed and unbilled amounts due from medical facilities or independent distributors (the "Customer"). Upon completion of a procedure, revenue is recognized and an unbilled receivable is recorded. Under Accounting Standards Codification ("ASC") No. 2014-09, Revenue from Contracts with Customers ("Topic 606" or "ASC 606"), an enforceable contract is met either at or prior to the procedure being performed. Upon receipt of a purchase order from the Customer, the billed receivable is recorded and the unbilled receivable is reversed. As a result, the unbilled receivable balance fluctuates based on the timing of the Company's receipt of purchase orders from the medical facilities. In estimating whether accounts receivable can be collected, the Company performs evaluations of customers and continuously monitors collections and payments and estimates an allowance for doubtful accounts based on the aging of the underlying invoices, collections experience to date and any specific collection issues that have been identified. The allowance for doubtful accounts is recorded in the period in which revenue is recorded or when collection risk is identified. Inventories Inventories consist of raw materials, work-in-process components and finished goods. Inventories are stated at the lower of cost, determined using the first-in first-out method, or net realizable value. The Company regularly reviews its inventory quantities on hand and related cost and records a provision for any excess or obsolete inventory based on its estimated forecast of product demand and existing product configurations. The Company also reviews its inventory value to determine if it reflects the lower of cost or market, based on net realizable value. Appropriate consideration is given to inventory items sold at negative gross margin, purchase commitments and other factors in evaluating net realizable value. During the three and nine months ended September 30, 2020 , the Company recognized provisions of $0.4 million and $2.1 million , respectively, to adjust its inventory value to the lower of cost or net realizable value for estimated unused product related to known and potential cancelled cases, which is included in cost of revenue. During the three and nine months ended September 30, 2019 , the Company recognized provisions of $0.9 million and $2.2 million , respectively, to adjust its inventory value to the lower of cost or net realizable value for estimated unused product related to known and potential cancelled cases, which is included in cost of revenue. Property and equipment Property and equipment is stated at cost less accumulated depreciation and is depreciated using the straight-line method over the estimated useful lives of the respective assets. Leasehold improvements are amortized over their useful life or the life of the lease, whichever is shorter. Assets capitalized under capital leases are amortized in accordance with the respective class of assets and the amortization is included with depreciation expense. Maintenance and repair costs are expensed as incurred. Long-Lived Assets The Company tests impairment of long-lived assets when events or changes in circumstances indicate that the assets might be impaired. The amount of impairment, if any, is measured based on fair value, which is determined using estimated undiscounted cash flows to be generated from such assets or group of assets. During the three months ended September 30, 2020 , there were changes in circumstances that led the Company to believe that its long-lived assets may be impaired and as such, a Step 2 analysis was performed. The Company evaluated whether the estimated undiscounted cash flows, including estimated residual value, generated from the asset group were sufficient to support the carrying value of the assets. If the cash flow estimates or the significant operating assumptions upon which they are based change in the future, the Company may be required to record impairment charges. During the three and nine months ended September 30, 2020 and 2019, no such impairment charges were recognized. Leases The Company adopted Accounting Standards Update ("ASU") No. 2016-02-Leases ("Topic 842" or "ASC 842"), as of January 1, 2019, in accordance with ASU No. 2018-11-Leases ("Topic 842" or "ASU 2018-11"), issued by the Financial Accounting Standards Board (the "FASB") in July 2018. ASU 2018-11 allows an entity to elect not to recast its comparative periods in the period of adoption when transitioning to ASC 842 (the “Comparatives Under 840 Option”). Effectively, an entity would be permitted to change its date of initial application to the beginning of the period of adoption of ASC 842. In doing so, the entity would apply ASC 840 in the comparative periods and provide the disclosures required by ASC 840 for all periods that continue to be presented in accordance with ASC 840. Further, the entity would recognize the effects of applying ASC 842 as a cumulative-effect adjustment to retained earnings as of the effective date. Under the Comparatives Under 840 Option, this date would represent the date of initial application. The Company is not required to restate comparative periods for the effects of applying ASC 842, provide the disclosures required by ASC 842 for the comparative periods, nor change how the transition requirements apply, only when the transition requirements apply. The Company elected to report results for periods after January 1, 2019 under ASC 842 and prior period amounts are reported in accordance with ASC 840. The Company has elected not to separate non-lease components from all classes of leases. Non-lease components have been accounted for as part of the single lease component to which they are related. Leases with an initial term of 12 months or less are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. The Company has elected the hindsight practical expedient to determine the lease term for existing leases. This practical expedient enables an entity to use hindsight in determining the lease term when considering options to extend and terminate leases as well as purchase the underlying assets. Adoption of the new standard resulted in the recording of additional right-of-use assets and lease liabilities of $7.0 million and $7.7 million , respectively, as of January 1, 2019. The difference between the additional lease assets and lease liabilities is related to deferred rent, which was previously recorded as deferred rent within Accrued expenses and Other long-term liabilities under ASC 840. The operating lease right-of-use assets are subsequently assessed for impairment in accordance with the Company's accounting policy for long-lived assets. The adoption of the standard did not impact the Company’s consolidated net earnings and had no impact on cash flows. Revenue Recognition Product Revenue Recognition Revenue is recognized when, or as, obligations under the terms of a contract are satisfied, which occurs when control of the promised products or services is transferred to customers. Revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer (“transaction price”). When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying the practical expedient in paragraph 606-10-32-18, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component as of September 30, 2020 . Payment is typically due between 30 and 60 days from invoice. To the extent that the transaction price includes variable consideration, such as prompt-pay discounts or rebates, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value to which the Company expects to be entitled. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Actual amounts of consideration ultimately received may differ from the Company's estimates. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. If the contract contains a single performance obligation, the entire transaction price is allocated to the single performance obligation. Contracts that contain multiple performance obligations require an allocation of the transaction price based on the estimated relative standalone selling prices of the promised products or services underlying each performance obligation. The Company determines standalone selling prices based on observable prices or a cost-plus margin approach when one is not available. Revenue is recognized at the time the related performance obligation is satisfied by transferring control of a promised good or service to a customer. The Company's performance obligations are satisfied at the same time, typically upon surgery, therefore, product revenue is recognized at a point in time upon completion of the surgery. Since the Company does not have contracts that extend beyond a duration of one year, there is no transaction price related to performance obligations that have not been satisfied. Certain customer contracts include terms that allow the Company to bill for orders that are cancelled after the product is manufactured and could result in revenue recognition over time. However, the impact of adopting over time revenue recognition was deemed immaterial. Unconditional rights to consideration are reported as receivables. Incidental items that are immaterial in the context of the contract are recognized as expense. Royalty and Licensing Revenue Recognition The Company receives ongoing sales-based royalties under its agreement with MicroPort Orthopedics Inc., a wholly owned subsidiary of MicroPort Scientific Corporation. Royalty revenue is recorded at the expected value of the royalty revenue. On September 30, 2019 the Company entered into the Stryker Agreements. The Company determined that the Asset Purchase Agreement and the License Agreement are within the scope of ASC 606. Under the Asset Purchase Agreement and License Agreement, the Company is required to provide certain assets and the right to use the license for a specific purpose. The assets and the right to use the license are highly interdependent and considered one performance obligation. The Company bifurcated the total transaction price of $ 30.0 million into two components; $ 5.0 million related to cost reimbursement for other services (development) and $ 25.0 million allocated to royalty revenue determined using the residual approach of deducting the cost reimbursement component from the total transaction price. The arrangement does not contain a significant financing component. The Company records a contract liability when there is an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer. The Company has concluded that Stryker meets the definition of a customer for a portion of the obligations under the Stryker Agreements. At September 30, 2020 , the Company recorded $14.0 million as a short-term contract liability related to consideration received from the customer under the Asset Purchase Agreement and Development Agreement. The Company concluded the license rights under the License Agreement will be functional when FDA 510(k) clearance is received as required under Milestone 3 in the License Agreement, or upon termination by Stryker and Stryker's election to purchase the license rights. On May 22, 2020 the Company entered into a Settlement and License Agreement with Zimmer Biomet, pursuant to which both parties have agreed to terms for resolving all of their existing patent disputes. In consideration of the licenses, releases, covenants and other immunities granted by the Company to Zimmer Biomet, Zimmer Biomet was required to pay the Company $3.5 million promptly after execution of the Settlement and License Agreement, which it has, and additional payments on specified dates through January 15, 2021, for a total amount payable of $9.6 million . The agreement provides for the grant of the licenses, covenants-not-to-sue, releases, and other significant deliverables upon execution of the contract. These individual rights are not accounted for as separate performance obligations as (i) the nature of the promise, within the context of the agreement, is to transfer combined items to which the promised rights are inputs and (ii) the Company's promise to transfer each individual right described above to Zimmer Biomet is not separately identifiable from other promises in the agreement. As a result, the Company accounts for the promises in the agreement as a single performance obligation. Zimmer Biomet legally obtained control of the license and other rights upon execution of the contract. As such, the earnings process is complete and revenue was recognized upon the execution of the contract, when collectability became probable and all other revenue recognition criteria had been met within the scope of ASC 606. In connection with the settlement agreement, the Company recognized revenue of $9.6 million during the nine months ended September 30, 2020 (of which $8.5 million has been paid to the Company by Zimmer Biomet as of November 4, 2020). See “Note H—Commitments and Contingencies, Legal proceedings” for further discussion of the Zimmer Biomet settlement. Disaggregation of Revenue See " Note K—Segment and Geographic Data " for disaggregated product revenue by geography. Variable Consideration Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which reserves are established and which result from rebates that are offered within contracts between the Company and some of its customers. The amount of variable consideration which is included in the transaction price may be constrained, and is included in the net sales price only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in a future period. The following table summarizes activity for rebate allowance reserve (in thousands): September 30, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 113 145 Adjustment related to prior period sales (1 ) 20 Payments or credits issued to customer (80 ) (134 ) Ending Balance $ 159 $ 127 Costs to Obtain and Fulfill a Contract The Company currently expenses commissions paid for obtaining product sales. Sales commissions are paid following the manufacture and implementation of the implant. Due to the period being less than one year, the Company will apply the practical expedient, whereby the Company recognizes the incremental costs of obtaining contracts as an expense when incurred if the amortization period of the assets that the Company otherwise would have recognized is one year or less. These costs are included in sales and marketing expense. Further, the Company incurs costs to buy, build, replenish, restock, sterilize and replace the reusable instrumentation trays associated with the sale of its products and services. The reusable instrument trays are not contract specific and are used for multiple contracts and customers, therefore does not meet the criteria to capitalize under ASC 606. Shipping and handling costs Shipping and handling activities prior to the transfer of control to the customer (e.g., when control transfers after delivery) are considered fulfillment activities, and not performance obligations. Amounts invoiced to customers for shipping and handling are classified as revenue. Shipping and handling costs incurred are included in general and administrative expense. Shipping and handling expense was $0.4 million and $0.3 million for the three months ended September 30, 2020 and 2019 , respectively, and $1.1 million and $1.3 million for the nine months ended September 30, 2020 and 2019 , respectively. Taxes collected from customers and remitted to government authorities The Company’s policy is to present taxes collected from customers and remitted to government authorities on a net basis and not to include tax amounts in revenue. Research and development expense The Company’s research and development costs consist of engineering, product development, quality assurance, clinical and regulatory expense. These costs primarily relate to employee compensation, including salary, benefits and stock-based compensation. The Company also incurs costs related to consulting fees, revenue share, materials and supplies, and marketing studies, including data management and associated travel expense. Research and development costs are expensed as incurred. Advertising expense Advertising costs are expensed as incurred, which are included in sales and marketing. Advertising expense was $0.1 million and $0.2 million for the three months ended September 30, 2020 and 2019 , respectively, and $0.3 million for each of the nine months ended September 30, 2020 and 2019 . Segment reporting Operating segments are defined as components of an enterprise about which separate financial information is available and is evaluated on a regular basis by the chief operating decision-maker, or decision-making group, in deciding how to allocate resources to an individual segment and in assessing performance of the segment. The Company’s chief operating decision-maker is its chief executive officer. The Company’s chief executive officer reviews financial information presented on an aggregate basis for purposes of allocating resources and evaluating financial performance. The Company has one business segment and there are no segment managers who are held accountable for operations, operating results and plans for products or components below the aggregate Company level. Accordingly, in light of the Company’s current product offerings, management has determined that the primary form of internal reporting is aligned with the offering of the Conformis personalized joint replacement products and that the Company operates as one segment. See “ Note K—Segment and Geographic Data .” Foreign currency translation and transactions The assets and liabilities of the Company’s foreign operations are translated into U.S. dollars at current exchange rates at the balance sheet date, and income and expense items are translated at average rates of exchange prevailing during the quarter. Net translation gains and losses are recorded in Accumulated other comprehensive (loss) income. Gains and losses from foreign currency transactions denominated in foreign currencies, including intercompany balances not of a long-term investment nature, are included in the Consolidated Statements of Operations. Income taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax bases, operating losses and tax credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized as income in the period that includes the enactment date. In evaluating the need for a valuation allowance, the Company considers all reasonably available positive and negative evidence, including recent earnings, expectations of future taxable income and the character of that income. In estimating future taxable income, the Company relies upon assumptions and estimates of future activity including the reversal of temporary differences. Presently, the Company believes that a full valuation allowance is required to reduce deferred tax assets to the amount expected to be realized. The tax benefit from an uncertain tax position is only recognized if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from these positions are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate resolution. The Company reviews its tax positions on an annual basis and more frequently as facts surrounding tax positions change. Based on these future events, the Company may recognize uncertain tax positions or reverse current uncertain tax positions, the impact of which would affect the consolidated financial statements. The Company has operations in Germany. The operating results of German operations will be permanently reinvested in that jurisdiction. As a result, the Company has only provided for income taxes at local rates when required. In April 2020, new interpretations of a German law related to intellectual property and withholding tax were released. The Company is currently evaluating whether the interpretations will have an impact on its consolidated financial statements. The Company is subject to U.S. federal, state, and foreign income taxes. The Company recorded a provision for income taxes of $20,000 and $21,000 for the three months ended September 30, 2020 and 2019 , respectively, and $17,000 and $35,000 for the nine months ended September 30, 2020 and 2019 , respectively. The Company recognizes interest and penalties related to income taxes as a component of income tax expense. As of September 30, 2020 and 2019 , a cumulative balance of $42,000 and $47,000 of interest and penalties had been accrued, respectively. On March 27, 2020, the U.S. government enacted the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") which included modifications to the limitation on business interest expense, net operating loss provisions, and other various U.S. tax law updates. The Company does not expect that these aspects of the CARES Act will have a material impact on its consolidated financial statements. Stock-based compensation The Company accounts for stock-based compensation in accordance with ASC 718, Stock Based Compensation ("ASC 718"). ASC 718 requires all stock-based payments to employees and consultants, including grants of stock options, to be recognized in the consolidated statements of operations based on their fair values. The Company uses the Black-Scholes option pricing model to determine the weighted-average fair value of options granted and recognizes the compensation expense of stock-based awards on a straight-line basis over the vesting period of the award. The determination of the fair value of stock-based payment awards utilizing the Black-Scholes option pricing model is affected by the stock price, exercise price, and a number of assumptions, including expected volatility of the stock, expected life of the option, risk-free interest rate and expected dividends on the stock. The Company evaluates the assumptions used to value the awards at each grant date and if factors change and different assumptions are utilized, stock-based compensation expense may differ significantly from what has been recorded in the past. If there are any modifications or cancellations of the underlying unvested securities, the Company may be required to accelerate, increase or cancel any remaining unearned stock-based compensation expense. Net loss per share The Company calculates net income (loss) per share in accordance with ASC 260, "Earnings per Share." Basic earnings per share (“EPS”) is calculated by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period, without consideration for common stock equivalents. Diluted EPS is computed by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury stock method. The following table sets forth the computation of basic and diluted earnings per share attributable to stockholders (in thousands, except share and per share data): Three Months Ended September 30, Nine Months Ended September 30, (in thousands, except share and per share data) 2020 2019 2020 2019 Numerator: Basic and diluted loss per share Net loss $ (6,183 ) $ (8,701 ) $ (17,671 ) $ (23,045 ) Denominator: Basic and diluted weighted average shares 71,224,786 64,750,275 69,799,495 63,651,412 Loss per share attributable to Conformis, Inc. stockholders: Basic and diluted $ (0.09 ) $ (0.13 ) $ (0.25 ) $ (0.36 ) The following table sets forth potential shares of common stock equivalents that are not included in the calculation of diluted net loss per share because to do so would be anti-dilutive as of the end of each period presented: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Stock options and restricted stock awards 694,817 2,588,330 993,012 3,340,154

Accounts Receivable

Accounts Receivable	9 Months Ended
	Sep. 30, 2020
Accounts Receivable, after Allowance for Credit Loss, Current [Abstract]
Accounts Receivable	Accounts Receivable Accounts receivable consisted of the following (in thousands): September 30, December 31, Total receivables $ 9,308 $ 11,401 Allowance for doubtful accounts and returns (328 ) (335 ) Accounts receivable, net $ 8,980 $ 11,066 Accounts receivable included unbilled receivable of $1.4 million and $2.1 million at September 30, 2020 and December 31, 2019 , respectively. Write-offs related to accounts receivable were approximately $0 and $38,000 for the three months ended September 30, 2020 and 2019 , respectively, and $71,000 and $70,000 for the nine months ended September 30, 2020 and 2019 , respectively. Summary of allowance for doubtful accounts and returns activity was as follows (in thousands): September 30, December 31, Beginning balance $ (335 ) $ (390 ) Provision for bad debts on trade receivables (72 ) (106 ) Other allowances 8 (26 ) Accounts receivable write offs 71 187 Ending balance $ (328 ) $ (335 )

Inventories

Inventories	9 Months Ended
	Sep. 30, 2020
Inventory Disclosure [Abstract]
Inventories	Inventories Inventories consisted of the following (in thousands): September 30, December 31, Raw Material $ 6,270 $ 6,171 Work in process 1,196 1,717 Finished goods 5,443 4,186 Total Inventories $ 12,909 $ 12,074

Property and Equipment

Property and Equipment	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment	Property and Equipment Property and equipment consisted of the following (in thousands): Estimated September 30, 2020 December 31, 2019 Equipment 5-7 $ 19,362 $ 19,011 Furniture and fixtures 5-7 864 864 Computer and software 3 9,801 9,561 Leasehold improvements 3-7 2,081 2,008 Reusable instruments 5 5,739 3,402 Total property and equipment 37,847 34,846 Accumulated depreciation (24,782 ) (21,490 ) Property and equipment, net $ 13,065 $ 13,356 Depreciation expense related to property and equipment was $1.1 million and $1.0 million for the three months ended September 30, 2020 and 2019 , respectively, and $3.3 million and $3.1 million for the nine months ended September 30, 2020 and 2019 , respectively.

Accrued Expenses

Accrued Expenses	9 Months Ended
	Sep. 30, 2020
Accrued Liabilities and Other Liabilities [Abstract]
Accrued Expenses	Accrued Expenses Accrued expenses consisted of the following (in thousands): September 30, December 31, Accrued employee compensation $ 3,413 $ 3,198 Accrued legal expense 1,578 310 Accrued consulting expense 21 21 Accrued vendor charges 641 1,037 Accrued revenue share expense 597 1,050 Accrued clinical trial expense 251 394 Accrued other 1,221 1,125 $ 7,722 $ 7,135

Leases

Leases	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Leases	Leases The Company maintains its corporate headquarters in a leased building located in Billerica, Massachusetts. The Company maintains its manufacturing facilities in leased buildings located in Wilmington, Massachusetts and Wallingford, Connecticut. The Company's leases have remaining lease terms of approximately one to seven years, some of which include one or more options to extend the leases for up to five years per renewal. The exercise of lease renewal options is at the sole discretion of the Company. The amounts disclosed in the Consolidated Balance Sheet pertaining to right-of-use assets and lease liabilities are measured based on management’s current expectations of exercising its available renewal options. The Company’s existing leases are not subject to any restrictions or covenants which preclude its ability to pay dividends, obtain financing, or enter into additional leases. As of September 30, 2020 , the Company had not entered into any leases which have not yet commenced which would entitle the Company to significant rights or create additional obligations. The Company uses either its incremental borrowing rate or the implicit rate in the lease agreement as the basis to calculate the present value of future lease payments at lease commencement. The incremental borrowing rate represents the rate the Company would have to pay to borrow funds on a collateralized basis over a similar term and in a similar economic environment. The components of lease expense and related cash flows were as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rent expense $ 381 $ 381 $ 1,144 $ 1,145 Variable lease cost (1) 88 90 265 289 $ 469 $ 471 $ 1,409 $ 1,434 (1) Variable operating lease expenses consist primarily of common area maintenance and real estate taxes for the three and nine months ended September 30, 2020 and 2019 , respectively. As of September 30, 2020 , the remaining weighted-average lease term of the operating leases was 4.4 years and the weighted-average discount rate was 6.0% . The future minimum rental payments under these agreements as of September 30, 2020 were as follows (in thousands): Year Minimum Lease Payments 2020 remainder of year 406 2021 1,633 2022 1,399 2023 1,053 After 2023 1,885 Total lease payments $ 6,376 Present value adjustment (776 ) Present value of lease liabilities $ 5,600

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Note H—Commitments and Contingencies License and revenue share agreements Revenue share agreements The Company is party to revenue share agreements with certain past and present members of its scientific advisory board under which these advisors agreed to participate on a scientific advisory board and to assist with the development of the Company’s personalized implant products and related intellectual property. These agreements provide that the Company will pay the advisor a specified percentage of the Company’s net revenue, ranging from 0.1 % to 1.33% , with respect to the Company’s products on which the advisor made a technical contribution or, in some cases, products covered by one or more claims of one or more Company patents on which the advisor is a named inventor. The specific percentage is determined by reference to product classifications set forth in the agreement and is often tiered based on the level of net revenue collected by the Company on such product sales. The Company’s payment obligations under these agreements typically expire a fixed number of years after expiration or termination of the agreement or a fixed number of years after the first sale of a product, but in some cases expire on a product-by-product basis or expiration of the last to expire of the Company’s patents where the advisor is a named inventor that claims the applicable product. The Company incurred aggregate revenue share expense including all amounts payable under the Company’s scientific advisory board revenue share agreements of $0.4 million during the three months ended September 30, 2020 , representing 2.7% of product revenue and $1.1 million during the nine months ended September 30, 2020 , representing 2.6% of product revenue, $0.6 million during the three months ended September 30, 2019 , representing 3.7% of product revenue and $1.2 million during the nine months ended September 30, 2019 , representing 2.2% of product revenue. Revenue share expense is included in research and development. Other obligations In the ordinary course of business, the Company is a party to certain non-cancellable contractual obligations typically related to product royalty and research and development. The Company accrues a liability for such matters when it is probable that future expenditures will be made and such expenditures can be reasonably estimated. There have been no contingent liabilities requiring accrual at September 30, 2020 or December 31, 2019 . Legal proceedings On August 15, 2019, the Company filed a lawsuit against Zimmer Biomet Holdings, Inc. and Zimmer, Inc., (together, “Zimmer Biomet”) in the United States District Court for the District of Delaware seeking damages for Zimmer Biomet's infringement of certain of the Company’s patents related to patient-specific instrument and implant systems. The complaint alleged that Zimmer Biomet’s multiple lines of patient-specific instruments, as well as the implant components used in conjunction with them, infringed four of the Company’s patents. The accused product lines included Zimmer Biomet's patient-specific instrument and implant systems for knee, shoulder, and hip replacement procedures. On November 5, 2019, Zimmer Biomet filed a lawsuit against the Company in the United States District Court for the District of Delaware, alleging that the Company infringed five patents owned by Zimmer Biomet. Zimmer Biomet alleged that the Company’s iTotal CR and iTotal PS products infringed all five asserted patents, that the Company’s iDuo product infringed three of the asserted patents, and that the Company’s iUni product infringed two of the asserted patents. On January 13, 2020, Zimmer Biomet filed a motion to dismiss the Company’s complaint, and the Company filed its answer to Zimmer Biomet’s complaint, denying that the Company’s products infringed Zimmer Biomet’s asserted patents. The Company’s answer also alleged that Zimmer Biomet’s asserted patents were invalid. On May 22, 2020 , the Company entered into a Settlement and License Agreement (the “Settlement and License Agreement”) with Zimmer Biomet, Zimmer US, Inc. and Biomet Manufacturing, LLC (collectively, “Zimmer Biomet”), pursuant to which the parties agreed to terms for resolving their existing patent disputes. Under the Settlement and License Agreement, the Company and Zimmer Biomet agreed to dismiss both outstanding patent infringement lawsuits between the parties. Pursuant to the Settlement and License Agreement, the Company granted to Zimmer Biomet a royalty-free, non-exclusive, worldwide license to certain of the Company’s patents for Zimmer Biomet’s patient-specific instrumentation used with off-the-shelf knee, hip, and shoulder implants, and Zimmer granted to Conformis a fully paid-up, royalty-free, non-exclusive, worldwide license to certain Zimmer Biomet patents for the Company’s implants and patient-specific instruments for the knee. Zimmer Biomet was required to pay the Company $3.5 million promptly after execution of the Settlement and License Agreement, which it did. Zimmer Biomet is also required to make additional payments to the Company on specified dates through January 15, 2021, for a total amount payable of $9.6 million , in consideration of the licenses, releases and other immunities granted by the Company to Zimmer Biomet. As of November 4, 2020, the Company had received total payments of $8.5 million . No payment is due from the Company to Zimmer Biomet . On August 29, 2019, the Company filed a lawsuit against Medacta USA, Inc. in the United States District Court for the District of Delaware. The Company amended its complaint on December 23, 2019, and again on October 14, 2020, adding Medacta International SA (Medacta USA, Inc.’s parent company) as a defendant (Medacta USA, Inc. and Medacta International SA are referred to, together, as “Medacta”). The Company is seeking damages for Medacta’s infringement of certain of the Company’s patents related to patient-specific instrument and implant systems, alleging that Medacta’s multiple lines of patient-specific instruments, as well as the implant components used in conjunction with them, infringe four of the Company’s patents. The accused product lines include Medacta patient-specific instrument and implant systems for knee and shoulder replacement procedures. On January 6, 2020, Medacta filed its answer to the Company's original complaint, denying that its patient-specific instrument and implant systems infringe the patents asserted by the Company. Medacta’s answer also alleges the affirmative defense that the Company's asserted patents are invalid. The Company expects that Medacta will similarly respond to our amended complaint. Discovery in the lawsuit has commenced and is ongoing. On March 20, 2020, Osteoplastics LLC ("Osteoplastics"), filed a lawsuit against the Company in the United States District Court for the District of Delaware, and Osteoplastics amended its complaint on April 2, 2020. Osteoplastics alleges that the Company’s proprietary software, including the Company’s iFit software platform, and the Company’s use of its proprietary software for designing and manufacturing medical devices, including implants, infringes seven patents owned by Osteoplastics. On June 15, 2020, the Company filed a motion to dismiss Osteoplastics’ complaint. The court has not yet ruled on the motion. On April 24, 2020, the Company filed a lawsuit against Wright Medical Technology, Inc. and Tornier, Inc. (together, “Wright Medical”) in the United States District Court for the District of Delaware. The Company is seeking damages for Wright Medical’s infringement of certain of the Company's patents related to patient-specific instrument and implant systems. The complaint alleges that Wright Medical’s multiple lines of patient-specific shoulder instruments, as well as the implant components used in conjunction with them, infringe four of the Company’s patents. The accused product lines include Wright Medical’s Tornier Blueprint™ 3D Planning + PSI shoulder replacement systems. On May 8, 2020, the Company and an individual plaintiff filed a lawsuit against Aetna, Inc. and Aetna Life Insurance Company (together, “Aetna”) in the United States District Court for the District of Massachusetts seeking damages for Aetna’s improper denial of coverage for personalized knee implants under its health plans and the ones it administers. The Company amended its complaint on August 13, 2020, alleging that Aetna has violated its duties under state and federal law, including the Employee Retirement Income Security Act. On August 27, 2020, Aetna filed a motion to dismiss the amended complaint. The court has not yet ruled on the motion. Adverse outcomes of these lawsuits could have a material adverse effect on the Company's business, financial condition or results of operations. The Company is presently unable to predict the outcome of these lawsuits or to reasonably estimate a range of potential losses, if any, related to the lawsuits. Legal costs associated with legal proceedings are accrued as incurred. Indemnification In the normal course of business, the Company enters into contracts and agreements that contain a variety of representations and warranties and provide for general indemnifications. The Company’s exposure under these agreements is unknown because it involves claims that may be made against the Company in the future, but have not yet been made. To date, the Company has not paid any claims or been required to defend any action related to its indemnification obligations. However, the Company may record charges in the future as a result of these indemnification obligations. In accordance with its bylaws, the Company has indemnification obligations to its officers and directors for certain events or occurrences, subject to certain limits, while they are serving at the Company’s request in such capacity. There have been no claims to date and the Company has a director and officer insurance policy that would be expected to enable it to recover a portion of any amounts paid for future claims.

Debt and Notes Payable

Debt and Notes Payable	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Debt and Notes Payable	Note I—Debt and Notes Payable Long-term debt consisted of the following (in thousands): September 30, December 31, PPP "Term Loan" 4,720 — Innovatus, Term Loan 20,000 20,000 Innovatus, Term Loan accrued payment-in-kind interest 645 262 Less unamortized debt issuance costs (532 ) (639 ) Long-term debt, less debt issuance costs $ 24,833 $ 19,623 Principal payments, including the Term Loan Basic Interest Rate in-kind (described below), due as of September 30, 2020 consisted of the following (in thousands): Principal Payment 2020 (remainder of the year) — 2021 — 2022 4,720 2023 8,986 2024 12,580 Total $ 26,286 2017 Secured Loan Agreement On January 6, 2017, the Company entered into the 2017 Secured Loan Agreement with Oxford. Through the 2017 Secured Loan Agreement, the Company accessed $15 million under Term Loan A at closing and an additional $15 million of borrowings under Term Loan B on June 30, 2017. On December 13, 2018, the Company entered into a fifth amendment (the "Fifth Amendment") to the 2017 Secured Loan Agreement, with Oxford, and pursuant to the Fifth Amendment, the Company pre-paid $15 million aggregate principal amount of the $30 million outstanding principal amount, as a pro rata portion of the Term A Loan and Term B Loan, together with accrued and unpaid interest thereon and a pro rata prepayment fee and final payment. Under the Fifth Amendment, the Company's cash collateral requirement was reduced to $5 million . On June 25, 2019, the Company elected to prepay the remainder of the Oxford term loan outstanding (along with accrued interest and applicable final payment and prepayment fee) using the proceeds from the 2019 Secured Loan Agreement. The prepayment of the debt was accounted for as a debt extinguishment and the Company incurred a loss on the extinguishment recognized in interest expense of $1.1 million . 2019 Secured Loan Agreement On June 25, 2019, the Company entered into the 2019 Secured Loan Agreement with Innovatus, as collateral agent and lender, East West Bank and the Lenders, pursuant to which the Lenders agreed to make term loans and revolving credit facility to the Company to repay existing indebtedness, for working capital and general business purposes, in a principal amount of up to $30 million . The term loan facility established under the 2019 Secured Loan Agreement is secured by substantially all of the Company's and its U.S. subsidiaries' properties, rights and assets. The 2019 Secured Loan Agreement includes a trailing six months' revenue test, a liquidity covenant and an additional liquidity covenant that is applicable if there are borrowings under the revolving credit facility. The 2019 Secured Loan Agreement also includes customary representations, affirmative and negative covenants. Additionally, the 2019 Secured Loan Agreement includes events of default, the occurrence and continuation of which could cause interest to be charged at the rate that is otherwise applicable plus 5.0% and would provide Innovatus, as collateral agent, with the right to accelerate all obligations under the 2019 Secured Loan Agreement and to exercise remedies against the Company and the collateral securing the credit facility, including foreclosure against assets securing the credit facilities, including the Company's cash. These events of default include, among other things, the Company’s failure to pay any amounts due under the credit facility, a breach of covenants under the credit facility, the Company’s insolvency, a material adverse change, the occurrence of any default under certain other indebtedness in an amount greater than $250,000 , one or more judgments against the Company in an amount greater than $500,000 , changes with respect to governmental approvals and FDA actions. On July 1, 2020, the Company entered into a Third Amendment to its Loan and Security Agreement, dated as of June 25, 2019. The Amendment, among other things, waives the trailing six-month revenue covenant milestones that apply to the quarters ending June 30, September 30 and December 31, 2020 under the Loan Agreement, and reduces the revenue covenant milestones that apply thereafter, delays until June 25, 2021 the Company’s option to prepay all, but not less than all, of the term loans advanced under the Loan Agreement and includes a new covenant that the Company raise additional capital. The Amendment also increases the Company’s minimum cash covenant to $5.0 million until December 31, 2020, provided that such minimum cash covenant shall be increased to $10.0 million , commencing on January 1, 2021, if the Company has not yet satisfied the new covenant relating to raising capital. The capital raise covenant in the Amendment specifies that on or before December 31, 2020, the Company shall receive aggregate gross cash proceeds of not less than $20.0 million from (i) the sale and issuance of the Company's equity securities (including, without limitation, by means of ATM offerings, private placements, follow on public offerings), (ii) net payments received from any of patent infringement disputes with Zimmer Biomet on or after July 1, 2020 and on or before December 31 2020, (iii) net payments received from any of the Company's other patent infringement disputes with any other party not specified in clause (ii), (iv) monetization of R&D tax credits or NOLs as part of any current or future 2020 government stimulus packages, or (v) governmental grants that are not (in whole or in part) in the form of indebtedness, or any combination of two or more of the foregoing. As of September 30, 2020 , as a result of the proceeds received under the registered direct offering, the Company was able to satisfy the capital raise covenant, which required the Company to raise $20.0 million on or before December 31, 2020. As of September 30, 2020 , the Company was not in breach of covenants under the 2019 Secured Loan Agreement. Term Loan - Innovatus The term loan under the 2019 Secured Loan Agreement bears interest at a floating annual rate calculated at the greater of the variable rate of interest as most recently announced by East West Bank as prime or 5.50% , plus 3.75% ("Term Loan Basic Interest Rate"), bearing an effective interest rate of 9.25% at September 30, 2020 . The Company is required to make interest only payments in arrears on the term loan for four years ; provided that the Company has elected to pay 2.50% per annum as such Term Loan Basic Interest Rate in-kind by adding an amount equal to 2.50% per annum of the outstanding principal amount to the then outstanding principal balance on a monthly basis until the third anniversary of the 2019 Secured Loan Agreement. Commencing July 1, 2023, and continuing on the payment date of each month thereafter, the Company is required to make consecutive equal monthly payments of principal of the term loan, together with accrued interest, in arrears, to the Lenders. All unpaid principal, accrued and unpaid interest with respect to the term loan, and a final fee in the amount of 5.0% of the term loan commitment, is due and payable in full on the term loan maturity date on June 1, 2024. At the Company’s option, the Company may prepay all, but not less than all, of the term loans advanced by the Lenders under the term loan facility after the second year, subject to a prepayment fee and an amount equal to the sum of all outstanding principal of the term loans plus accrued and unpaid interest thereon through the prepayment date, a final fee, plus all other amounts that are due and payable, including the Lenders' expenses and interest at the default rate with respect to any past due amounts. Revolving Credit Facility - East West Bank Under the 2019 Secured Loan Agreement, East West Bank will make loans of up to $10 million from time to time outstanding, subject to availability based on a borrowing base equal to (i) 85.00% of eligible customer accounts, subject to a maximum of 2.50% dilution based upon collections, minus (ii) the Company’s foreign accounts receivable credit insurance’s outstanding co-payment and minimum annual deductible (that has not been used at the applicable time). Advances under the revolving credit facility bear interest at a rate of 0.50% above the greater of East West Bank’s prime rate or 5.50% . Interest on the revolving advances is payable monthly in arrears. The revolving credit facility terminates and the principal and all amounts are due in full on June 25, 2024, provided that if an optional or mandatory prepayment (other than regularly scheduled payments) is made under the term loan, the Company must satisfy in full the obligations under the revolving credit line. The revolving credit facility requires a lockbox arrangement, which provides for all receipts to be swept daily to reduce the borrowings outstanding under the revolving credit facility. There were no amounts outstanding under the revolving credit facility at September 30, 2020 . PPP Loan- East West Bank On April 17, 2020, the Company entered into an approximately $4.7 million promissory note (the “PPP Note”) with East West Bank under the Paycheck Protection Program (“PPP”) offered by the U.S. Small Business Administration (the "SBA") to mitigate the negative financial and operational impacts of the COVID-19 pandemic. The interest rate on the PPP Note is a fixed rate of 1% per annum. The Company is required to make one payment of all outstanding principal plus all accrued unpaid interest on April 9, 2022 (the “Maturity Date”). The Company will pay regular monthly payments in an amount equal to one month’s accrued interest commencing on February 9, 2021, with all subsequent interest payments to be due on the same day of each month after that. All interest which accrues during the initial 10 months of the loan period will be deferred to and payable on the Maturity Date. According to the terms of the PPP, all or a portion of the loan may be fully forgiven if the funds are used for payroll costs (and at least 60% of the forgiven amount must have been used for payroll), interest on certain other outstanding debt, rent, and utilities. In accordance with the CARES Act, the Company used the proceeds of the loan primarily for payroll costs. The Company accounts for the PPP Note as a debt instrument in accordance with ASC 470-50-40-2, with the proceeds from the loan recognize as a long-term liability, less any debt issuance costs, within the consolidated balance sheet. Interest is accrued at the stated rate on a monthly basis by applying the interest method under ASC 835.

Stockholders' Equity

Stockholders' Equity	9 Months Ended
	Sep. 30, 2020
Stockholders' Equity Note [Abstract]
Shareholders' Equity	Stockholders’ Equity Common stock Common stockholders are entitled to dividends as and when declared by the board of directors, subject to the rights of holders of all classes of stock outstanding having priority rights as to dividends. There have been no dividends declared to date. Preferred stock The Company’s Restated Certificate of Incorporation authorizes the Company to issue 5,000,000 shares of preferred stock, $0.00001 par value, all of which is undesignated. No shares were issued and outstanding at September 30, 2020 and December 31, 2019 . Demand registration rights In conjunction with the Private Placement, on June 25, 2019, the Company entered into a registration rights agreement (the "Registration Rights Agreement"), with Innovatus, Innovatus Life Science Offshore Fund I, LP and Innovatus Life Sciences Offshore Fund I-A, LP (collectively, the "Innovatus Investors"), pursuant to which the Company agreed to register for resale the shares held by the Innovatus Investors (the “Shares”) under certain circumstances. Under the Registration Rights Agreement, in the event that the Company receives a written request from the Innovatus Investors that the Company file with the SEC a registration statement covering the resale of all of the Shares, the Company shall promptly but no later than 120 days after the date of such request prepare and file with the SEC such registration statement. The Innovatus Investors have agreed to use best efforts not to make such a request, including by effecting any planned sales of Shares under Rule 144 under the Securities Act. The Company has agreed to use commercially reasonable efforts to cause such registration statement to become effective and to keep such registration statement effective until the date the Shares covered by such registration statement have been sold or may be resold pursuant to Rule 144 without restriction. The Company has agreed to be responsible for all fees and expenses incurred in connection with the registration of the Shares. The Company has granted the Innovatus Investors customary indemnification rights in connection with the registration statement. The Innovatus Investors have also granted the Company customary indemnification rights in connection with the registration statement. Registered direct offering On September 23, 2020, the Company and a healthcare-focused institutional investor entered into a subscription agreement, pursuant to which the Company sold (i) 8,512,088 shares of its common stock and accompanying warrants to purchase up to 8,512,088 shares of common stock and (ii) pre-funded warrants to purchase up to 9,492,953 shares of common stock and accompanying warrants to purchase up to 9,492,953 shares of common stock in a registered direct offering for gross proceeds of approximately $17.3 million . The common stock (or pre-funded warrants in lieu thereof) and accompanying warrants were sold as units, each consisting of one share (or one pre-funded warrant to purchase one share of common stock in lieu thereof) and one warrant to purchase one share of common stock, at an offering price of $0.9581 per unit. The pre-funded warrants became exercisable immediately upon issuance, have an exercise price of $0.0001 per share and will be exercisable until all of the pre-funded warrants are exercised in full. The warrants became exercisable immediately upon issuance, have an exercise price of $0.8748 per share, and will expire five years from the date of issuance. The pre-funded warrants and the warrants each prohibit the holder from exercising any portion thereof to the extent that the holder would own more than 9.99% of the number of shares of common stock outstanding immediately after exercise. The number of shares issuable upon exercise of the warrants and pre-funded warrants and the exercise price of the warrants and pre-funded warrants is adjustable in the event of stock splits, stock dividends, combinations of shares and similar recapitalization transactions. The net proceeds to the Company from the offering, after deducting the placement agent's fees and other estimated offering expenses payable by the Company, was approximately $15.9 million . Warrants The Company has issued warrants to certain investors and consultants to purchase shares of the Company’s common stock. Based on the Company’s assessment of the warrants granted in 2013 and 2014 relative to ASC 480, Distinguishing Liabilities from Equity , such warrants are classified as equity. According to ASC 480, an entity shall classify as a liability any financial instrument, other than an outstanding share, that, at inception, both a) embodies an obligation to repurchase the issuer’s equity shares, or is indexed to such obligation and b) requires or may require the issuer to settle the obligation by transferring assets. The warrants do not contain any provision that requires the Company to repurchase the shares and are not indexed to such an obligation. The warrants also do not require the Company to settle by transferring assets. All warrants were exercisable immediately upon issuance. In connection with the September 23, 2020 registered direct offering, the Company issued 9,492,953 pre-funded common stock warrants with an exercise price of $0.0001 per share and an additional 18,005,041 common stock warrants with an exercise price of $0.8748 per share. All of the warrants are exercisable for one share of common stock and are exercisable immediately. The pre-funded warrants are exercisable indefinitely, while the additional warrants are exercisable for 5 years from the date of issuance. Based on the Company’s assessment of the warrants granted relative to ASC 480, Distinguishing Liabilities from Equity and ASC 815-40, Accounting for Derivative Financial Instruments Indexed to, and Potentially Settled in, a Company’s Own Stock, these warrants are classified as equity instruments. The fair value of the common stock warrants of approximately $10.2 million at the date of issuance was estimated using the Black-Scholes model which used the following inputs: term of 5 years , risk free rate of 0.28% , 0% dividend yield, volatility of 90.15% , an exercise price of $0.875 and share price of $0.833 per share based on the trading price of the Company’s common stock. Warrants to purchase 18,025,967 shares of common stock were outstanding as of September 30, 2020 and warrants to purchase 28,926 shares were outstanding as of December 31, 2019 . Outstanding common stock warrants are currently exercisable with varying exercise expiration dates from 2024 through 2025, and outstanding pre-funded warrants are exercisable until all of the pre-funded warrants are exercised in full . At September 30, 2020 and December 31, 2019 , the weighted average warrant exercise price per share for common stock and pre-funded warrants underlying the warrants and the weighted average contractual life was as follows: Number of Common Number of Pre-funded Warrants Weighted Weighted Average Remaining Contractual Life Number of Weighted Outstanding December 31, 2019 28,926 — $ 9.80 3.66 28,926 $ 9.80 Granted 18,005,041 — $ 0.88 4.98 18,005,041 $ 0.88 Granted- pre-funded warrants — 9,492,953 $ 0.0001 — 9,492,953 $ 0.0001 Exercised — — — — — — Cancelled/expired (8,000 ) — — — (8,000 ) — Outstanding September 30, 2020 18,025,967 9,492,953 $ 0.89 4.98 27,518,920 $ 0.89 Stock option plans As of September 30, 2020 , 278,010 shares of common stock were available for future issuance under the 2015 Stock Incentive Plan ("2015 Plan"). The 2015 Plan provides for an annual increase, to be added on the first day of each fiscal year, beginning with the fiscal year ending December 31, 2016 and continuing until, and including, the fiscal year ending December 31, 2025, equal to the lesser of (a) 3,000,000 shares of the Company's common stock, (b) 3% of the number of share of its common stock outstanding on the first day of such fiscal year and (c) an amount determined by the Board. Effective January 1, 2020, an additional 2,112,822 shares of the Company's common stock were added to the 2015 Plan under the terms of this provision. On April 29, 2019, the stockholders approved the Conformis, Inc. 2019 Sales Team Performance-Based Equity Incentive Plan ("2019 Sales Team Plan") for up to 3,000,000 shares of common stock available to grant to certain sales representatives or independent sales agents. The 2019 Sales Team Plan provides for the grant of performance-based equity, including incentive stock options, nonstatutory stock options, stock appreciation rights, restricted stock awards, restricted stock units and other stock-based awards. Shares covered by awards under the 2019 Sales Team Plan that expire or are terminated, surrendered, or cancelled without having been fully exercised or are forfeited in whole or in part (including as the result of shares subject to such award being repurchased by us at the original issuance price pursuant to a contractual repurchase right) or that result in any shares not being issued, will again be available for the grant of awards under the 2019 Sales Team Plan. Equity granted under the 2019 Sales Team Plan will expire ten years from the date of grant. As of September 30, 2020 , 2,756,481 shares of common stock were available for future issuance under the 2019 Sales Team Plan. Activity under all stock option plans was as follows: Number of Options Weighted Average Exercise Price per Share Aggregate Intrinsic Value (in Thousands) Outstanding December 31, 2019 1,802,463 $ 6.75 Granted 291,667 0.90 Expired (421,135 ) 7.48 Cancelled/Forfeited (12,433 ) 1.39 Outstanding September 30, 2020 1,660,562 $ 5.57 $ — Total vested and exercisable 1,260,040 $ 6.73 $ — The total fair value of stock options that vested during the three and nine months ended September 30, 2020 was $0.1 million and $0.4 million . The weighted average remaining contractual term for the total stock options outstanding was 5.18 years as of September 30, 2020 . The weighted average remaining contractual term for the total stock options vested and exercisable was 3.99 years as of September 30, 2020 . Restricted common stock award activity under the plan was as follows: Number of Shares Weighted Average Fair Value Unvested December 31, 2019 4,436,928 $ 1.54 Granted 4,166,296 0.96 Vested (1,562,132 ) 1.41 Forfeited (325,645 ) 1.19 Unvested September 30, 2020 6,715,447 $ 1.23 The total fair value of restricted common stock awards that vested during the three and nine months ended September 30, 2020 was $0.4 million and $2.2 million . Inducement Awards In February 2020, the Company granted inducement awards outside of the 2015 Plan and 2019 Sales Team Plan (i) to the Company's Chief Financial Officer in the form of an option to purchase 125,000 shares of the Company's common stock with an exercise price per share equal to $0.98 and 125,000 restricted stock units and (ii) to the Company's Senior Vice President, Operations in the form of an option to purchase 66,667 shares of the Company's common stock with an exercise price per share equal to $0.98 and 61,350 restricted stock units. The option and restricted stock unit awards were granted as inducements material to their commencement of employment with the Company in accordance with Nasdaq Listing Rule 5635(c)(4). In August 2020, the Company granted inducement awards outside of the 2015 Plan and 2019 Sales Team Plan to the Company's Vice President, US Marketing in the form of an option to purchase 100,000 shares of the Company's common stock with an exercise price per share equal to $0.7427 and 100,000 restricted stock units. The option and restricted stock unit awards were granted as inducements material to his commencement of employment with the Company in accordance with Nasdaq Listing Rule 5635(c)(4). Stock-based compensation The Company uses the Black-Scholes option pricing model to determine the fair value of stock options. The determination of the fair value of stock-based payment awards on the date of grant using a pricing model is affected by the value of the Company’s common stock as well as assumptions regarding a number of complex and subjective variables. The valuation of the Company’s common stock prior to its initial public offering was performed with the assistance of an independent third-party valuation firm using a methodology that includes various inputs including the Company’s historical and projected financial results, peer company public data and market metrics, such as risk-free interest and discount rates. As the valuations included unobservable inputs that were primarily based on the Company’s own assumptions, the inputs were considered level 3 inputs within the fair value hierarchy. The fair value of options at date of grant was estimated using the Black-Scholes option pricing model, based on the following assumptions: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Risk-free interest rate 0.38% 1.89% 1.14% 1.89% Expected term (in years) 6 6.00 6.16 6.00 Dividend yield —% —% —% —% Expected volatility 52.92% 55.80% 54.89% 55.80% Risk-free interest rate . The risk-free interest rate is based on U.S. Treasury zero-coupon issues with remaining terms similar to the expected term on the options. Expected term. The expected term of stock options represents the period the stock options are expected to remain outstanding and is based on the “SEC Shortcut Approach” as defined in “Share-Based Payment” (SAB 107) ASC 718-10-S99, “Compensation-Stock Compensation-Overall-SEC Materials,” which is the midpoint between the vesting date and the end of the contractual term. With certain stock option grants, the exercise price may exceed the fair value of the common stock. In these instances, the Company adjusts the expected term accordingly. Dividend yield. The Company has never declared or paid any cash dividends and does not plan to pay cash dividends in the foreseeable future, and, therefore, used an expected dividend yield of zero in the valuation model. Expected volatility. Expected volatility measures the amount that a stock price has fluctuated or is expected to fluctuate during a period. The Company has limited history of market prices of its common stock over the historical period equal in length to the expected term, and may sometimes estimate volatility using historical volatilities of similar public entities. Forfeitures. The Company recognizes forfeitures as they occur. Stock-based compensation expense was $1.0 million and $0.1 million for the three months ended September 30, 2020 and 2019 , respectively and $2.6 million and $2.2 million for the nine months ended September 30, 2020 and 2019 , respectively. Stock-based compensation expense was calculated based on awards ultimately expected to vest. To date, the amount of stock-based compensation capitalized as part of inventory was not material. The following is a summary of stock-based compensation expense (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Cost of revenues $ 29 $ (23 ) $ 43 $ 276 Sales and marketing 136 (11 ) 364 119 Research and development 166 (19 ) 480 440 General and administrative 641 126 1,696 1,344 $ 972 $ 73 $ 2,583 $ 2,179 As of September 30, 2020 , the Company had $0.4 million of total unrecognized compensation expense for options that will be recognized over a weighted average period of 2.54 years . As of September 30, 2020 , the Company had $6.5 million of total unrecognized compensation expense for restricted awards that will be recognized over a weighted average period of 2.58 years.

Segment and Geographic Data

Segment and Geographic Data	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Segment and Geographic Data	Note K—Segment and Geographic Data The Company operates as one reportable segment as described in Note B to the Consolidated Financial Statements. The countries in which the Company has local revenue generating operations have been combined into the following geographic areas: the United States (including Puerto Rico), Germany and the rest of world, which consists of Europe predominately (including the United Kingdom) and other foreign countries. Sales are attributable to a geographic area based upon the customer’s country of domicile. Net property, plant and equipment are based upon physical location of the assets. Geographic information consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Product revenue United States $ 14,139 $ 15,144 $ 36,298 $ 49,924 Germany 1,536 1,527 4,852 5,677 Rest of world 300 441 858 1,317 $ 15,975 $ 17,112 $ 42,008 $ 56,918 September 30, 2020 December 31, 2019 Property and equipment, net United States $ 13,023 $ 13,303 Germany 42 53 $ 13,065 $ 13,356

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Basis of presentation and use of estimates	Basis of presentation and use of estimates The preparation of consolidated financial statements in conformity with generally accepted accounting principles in the United States ("U.S. GAAP") requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the consolidated financial statements, and the reported amounts of revenue and expenses during the reporting periods. The most significant estimates used in these consolidated financial statements include revenue recognition, accounts receivable valuation, inventory reserves, purchase accounting, impairment assessments, equity instruments, stock compensation, income tax reserves and related allowances, and the lives of property and equipment, and valuation of right-of-use lease assets and lease liabilities. Actual results may differ from those estimates. The interim financial statements should be read in conjunction with the audited financial statements and notes theret
Concentrations of credit risk and other risks and uncertainties	Concentrations of credit risk and other risks and uncertainties Financial instruments that subject the Company to credit risk primarily consist of cash, cash equivalents, and accounts receivable. The Company maintains the majority of its cash with accredited financial institutions. The Company and its contract manufacturers rely on sole source suppliers and service providers for certain components. There can be no assurance that a shortage or stoppage of shipments of the materials or components that the Company purchases will not result in a delay in production or adversely affect the Company’s business. On an ongoing basis, the Company validates alternate suppliers relative to certain key components as needed.
Principles of consolidation	Principles of consolidation The consolidated financial statements include the accounts of the Company and its wholly owned subsidiaries: ImaTx, Inc.; ConforMIS Europe GmbH; ConforMIS UK Limited; ConforMIS Hong Kong Limited; and Conformis Cares LLC. All intercompany balances and transactions have been eliminated in consolidation.
Cash and cash equivalents	Cash, cash equivalents and restricted cash The Company considers all highly liquid investment instruments with original maturities of 90 days or less when purchased to be cash equivalents. The Company’s cash equivalents consist of demand deposits , money market accounts, money market funds, and repurchase agreements on deposit with certain financial institutions, in addition to cash deposits in excess of federally insured limits. Demand deposits and money market accounts are carried at cost which approximates their fair value. Money market funds are carried at fair value based upon level 1 inputs. Repurchase agreements are valued using level 2 inputs. The associated risk of concentration is mitigated by banking with credit worthy financial institutions.
Fair value of financial instruments	Fair value of financial instruments Certain of the Company’s financial instruments, including cash and cash equivalents (excluding money market funds), accounts receivable, accounts payable, accrued expenses and other liabilities are carried at cost, which approximates their fair value because of the short-term maturity. Based on borrowing rates currently available to the Company for loans with similar terms, the carrying value of the Company’s long-term debt approximates its fair value.
Accounts receivable and allowance for doubtful accounts	Accounts receivable and allowance for doubtful accounts Accounts receivable consist of billed and unbilled amounts due from medical facilities or independent distributors (the "Customer"). Upon completion of a procedure, revenue is recognized and an unbilled receivable is recorded. Under Accounting Standards Codification ("ASC") No. 2014-09, Revenue from Contracts with Customers ("Topic 606" or "ASC 606"), an enforceable contract is met either at or prior to the procedure being performed. Upon receipt of a purchase order from the Customer, the billed receivable is recorded and the unbilled receivable is reversed. As a result, the unbilled receivable balance fluctuates based on the timing of the Company's receipt of purchase orders from the medical facilities. In estimating whether accounts receivable can be collected, the Company performs evaluations of customers and continuously monitors collections and payments and estimates an allowance for doubtful accounts based on the aging of the underlying invoices, collections experience to date and any specific collection issues that have been identified. The allowance for doubtful accounts is recorded in the period in which revenue is recorded or when collection risk is identified.
Inventories	Inventories Inventories consist of raw materials, work-in-process components and finished goods. Inventories are stated at the lower of cost, determined using the first-in first-out method, or net realizable value. The Company regularly reviews its inventory quantities on hand and related cost and records a provision for any excess or obsolete inventory based on its estimated forecast of product demand and existing product configurations. The Company also reviews its inventory value to determine if it reflects the lower of cost or market, based on net realizable value. Appropriate consideration is given to inventory items sold at negative gross margin, purchase commitments and other factors in evaluating net realizable value.
Property and equipment	Property and equipment Property and equipment is stated at cost less accumulated depreciation and is depreciated using the straight-line method over the estimated useful lives of the respective assets. Leasehold improvements are amortized over their useful life or the life of the lease, whichever is shorter. Assets capitalized under capital leases are amortized in accordance with the respective class of assets and the amortization is included with depreciation expense. Maintenance and repair costs are expensed as incurred.
Intangibles and other long-lived assets	Long-Lived Assets The Company tests impairment of long-lived assets when events or changes in circumstances indicate that the assets might be impaired. The amount of impairment, if any, is measured based on fair value, which is determined using estimated undiscounted cash flows to be generated from such assets or group of assets. During the three months ended September 30, 2020 , there were changes in circumstances that led the Company to believe that its long-lived assets may be impaired and as such, a Step 2 analysis was performed. The Company evaluated whether the estimated undiscounted cash flows, including estimated residual value, generated from the asset group were sufficient to support the carrying value of the assets. If the cash flow estimates or the significant operating assumptions upon which they are based change in the future, the Company may be required to record impairment charges. During the three and nine months ended September 30, 2020 and 2019, no such impairment charges were recognized.
Leases	Leases The Company adopted Accounting Standards Update ("ASU") No. 2016-02-Leases ("Topic 842" or "ASC 842"), as of January 1, 2019, in accordance with ASU No. 2018-11-Leases ("Topic 842" or "ASU 2018-11"), issued by the Financial Accounting Standards Board (the "FASB") in July 2018. ASU 2018-11 allows an entity to elect not to recast its comparative periods in the period of adoption when transitioning to ASC 842 (the “Comparatives Under 840 Option”). Effectively, an entity would be permitted to change its date of initial application to the beginning of the period of adoption of ASC 842. In doing so, the entity would apply ASC 840 in the comparative periods and provide the disclosures required by ASC 840 for all periods that continue to be presented in accordance with ASC 840. Further, the entity would recognize the effects of applying ASC 842 as a cumulative-effect adjustment to retained earnings as of the effective date. Under the Comparatives Under 840 Option, this date would represent the date of initial application. The Company is not required to restate comparative periods for the effects of applying ASC 842, provide the disclosures required by ASC 842 for the comparative periods, nor change how the transition requirements apply, only when the transition requirements apply. The Company elected to report results for periods after January 1, 2019 under ASC 842 and prior period amounts are reported in accordance with ASC 840. The Company has elected not to separate non-lease components from all classes of leases. Non-lease components have been accounted for as part of the single lease component to which they are related. Leases with an initial term of 12 months or less are not recorded on the balance sheet; the Company recognizes lease expense for these leases on a straight-line basis over the lease term. The Company has elected the hindsight practical expedient to determine the lease term for existing leases. This practical expedient enables an entity to use hindsight in determining the lease term when considering options to extend and terminate leases as well as purchase the underlying assets. Adoption of the new standard resulted in the recording of additional right-of-use assets and lease liabilities of $7.0 million and $7.7 million , respectively, as of January 1, 2019. The difference between the additional lease assets and lease liabilities is related to deferred rent, which was previously recorded as deferred rent within Accrued expenses and Other long-term liabilities under ASC 840. The operating lease right-of-use assets are subsequently assessed for impairment in accordance with the Company's accounting policy for long-lived assets. The adoption of the standard did not impact the Company’s consolidated net earnings and had no impact on cash flows.
Revenue recognition	Revenue Recognition Product Revenue Recognition Revenue is recognized when, or as, obligations under the terms of a contract are satisfied, which occurs when control of the promised products or services is transferred to customers. Revenue is measured as the amount of consideration the Company expects to receive in exchange for transferring products or services to a customer (“transaction price”). When determining the transaction price of a contract, an adjustment is made if payment from a customer occurs either significantly before or significantly after performance, resulting in a significant financing component. Applying the practical expedient in paragraph 606-10-32-18, the Company does not assess whether a significant financing component exists if the period between when the Company performs its obligations under the contract and when the customer pays is one year or less. None of the Company’s contracts contained a significant financing component as of September 30, 2020 . Payment is typically due between 30 and 60 days from invoice. To the extent that the transaction price includes variable consideration, such as prompt-pay discounts or rebates, the Company estimates the amount of variable consideration that should be included in the transaction price utilizing the expected value to which the Company expects to be entitled. Variable consideration is included in the transaction price if, in the Company’s judgment, it is probable that a significant future reversal of cumulative revenue under the contract will not occur. Actual amounts of consideration ultimately received may differ from the Company's estimates. Estimates of variable consideration and determination of whether to include estimated amounts in the transaction price are based largely on an assessment of the Company’s anticipated performance and all information (historical, current and forecasted) that is reasonably available. If the contract contains a single performance obligation, the entire transaction price is allocated to the single performance obligation. Contracts that contain multiple performance obligations require an allocation of the transaction price based on the estimated relative standalone selling prices of the promised products or services underlying each performance obligation. The Company determines standalone selling prices based on observable prices or a cost-plus margin approach when one is not available. Revenue is recognized at the time the related performance obligation is satisfied by transferring control of a promised good or service to a customer. The Company's performance obligations are satisfied at the same time, typically upon surgery, therefore, product revenue is recognized at a point in time upon completion of the surgery. Since the Company does not have contracts that extend beyond a duration of one year, there is no transaction price related to performance obligations that have not been satisfied. Certain customer contracts include terms that allow the Company to bill for orders that are cancelled after the product is manufactured and could result in revenue recognition over time. However, the impact of adopting over time revenue recognition was deemed immaterial. Unconditional rights to consideration are reported as receivables. Incidental items that are immaterial in the context of the contract are recognized as expense. Royalty and Licensing Revenue Recognition The Company receives ongoing sales-based royalties under its agreement with MicroPort Orthopedics Inc., a wholly owned subsidiary of MicroPort Scientific Corporation. Royalty revenue is recorded at the expected value of the royalty revenue. On September 30, 2019 the Company entered into the Stryker Agreements. The Company determined that the Asset Purchase Agreement and the License Agreement are within the scope of ASC 606. Under the Asset Purchase Agreement and License Agreement, the Company is required to provide certain assets and the right to use the license for a specific purpose. The assets and the right to use the license are highly interdependent and considered one performance obligation. The Company bifurcated the total transaction price of $ 30.0 million into two components; $ 5.0 million related to cost reimbursement for other services (development) and $ 25.0 million allocated to royalty revenue determined using the residual approach of deducting the cost reimbursement component from the total transaction price. The arrangement does not contain a significant financing component. The Company records a contract liability when there is an obligation to transfer goods or services to a customer for which the Company has received consideration from the customer. The Company has concluded that Stryker meets the definition of a customer for a portion of the obligations under the Stryker Agreements. At September 30, 2020 , the Company recorded $14.0 million as a short-term contract liability related to consideration received from the customer under the Asset Purchase Agreement and Development Agreement. The Company concluded the license rights under the License Agreement will be functional when FDA 510(k) clearance is received as required under Milestone 3 in the License Agreement, or upon termination by Stryker and Stryker's election to purchase the license rights. On May 22, 2020 the Company entered into a Settlement and License Agreement with Zimmer Biomet, pursuant to which both parties have agreed to terms for resolving all of their existing patent disputes. In consideration of the licenses, releases, covenants and other immunities granted by the Company to Zimmer Biomet, Zimmer Biomet was required to pay the Company $3.5 million promptly after execution of the Settlement and License Agreement, which it has, and additional payments on specified dates through January 15, 2021, for a total amount payable of $9.6 million . The agreement provides for the grant of the licenses, covenants-not-to-sue, releases, and other significant deliverables upon execution of the contract. These individual rights are not accounted for as separate performance obligations as (i) the nature of the promise, within the context of the agreement, is to transfer combined items to which the promised rights are inputs and (ii) the Company's promise to transfer each individual right described above to Zimmer Biomet is not separately identifiable from other promises in the agreement. As a result, the Company accounts for the promises in the agreement as a single performance obligation. Zimmer Biomet legally obtained control of the license and other rights upon execution of the contract. As such, the earnings process is complete and revenue was recognized upon the execution of the contract, when collectability became probable and all other revenue recognition criteria had been met within the scope of ASC 606. In connection with the settlement agreement, the Company recognized revenue of $9.6 million during the nine months ended September 30, 2020 (of which $8.5 million has been paid to the Company by Zimmer Biomet as of November 4, 2020). See “Note H—Commitments and Contingencies, Legal proceedings” for further discussion of the Zimmer Biomet settlement. Disaggregation of Revenue See " Note K—Segment and Geographic Data " for disaggregated product revenue by geography. Variable Consideration Revenues from product sales are recorded at the net sales price (transaction price), which includes estimates of variable consideration for which reserves are established and which result from rebates that are offered within contracts between the Company and some of its customers. The amount of variable consideration which is included in the transaction price may be constrained, and is included in the net sales price only to the extent that it is probable that a significant reversal in the amount of the cumulative revenue recognized will not occur in a future period. The following table summarizes activity for rebate allowance reserve (in thousands): September 30, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 113 145 Adjustment related to prior period sales (1 ) 20 Payments or credits issued to customer (80 ) (134 ) Ending Balance $ 159 $ 127 Costs to Obtain and Fulfill a Contract The Company currently expenses commissions paid for obtaining product sales. Sales commissions are paid following the manufacture and implementation of the implant. Due to the period being less than one year, the Company will apply the practical expedient, whereby the Company recognizes the incremental costs of obtaining contracts as an expense when incurred if the amortization period of the assets that the Company otherwise would have recognized is one year or less. These costs are included in sales and marketing expense. Further, the Company incurs costs to buy, build, replenish, restock, sterilize and replace the reusable instrumentation trays associated with the sale of its products and services. The reusable instrument trays are not contract specific and are used for multiple contracts and customers, therefore does not meet the criteria to capitalize under ASC 606. Shipping and handling costs Shipping and handling activities prior to the transfer of control to the customer (e.g., when control transfers after delivery) are considered fulfillment activities, and not performance obligations. Amounts invoiced to customers for shipping and handling are classified as revenue. Shipping and handling costs incurred are included in general and administrative expense. Shipping and handling expense was $0.4 million and $0.3 million for the three months ended September 30, 2020 and 2019 , respectively, and $1.1 million and $1.3 million for the nine months ended September 30, 2020 and 2019 , respectively. Taxes collected from customers and remitted to government authorities The Company’s policy is to present taxes collected from customers and remitted to government authorities on a net basis and not to include tax amounts in revenue.
Research and development expense	Research and development expense The Company’s research and development costs consist of engineering, product development, quality assurance, clinical and regulatory expense. These costs primarily relate to employee compensation, including salary, benefits and stock-based compensation. The Company also incurs costs related to consulting fees, revenue share, materials and supplies, and marketing studies, including data management and associated travel expense. Research and development costs are expensed as incurred.
Advertising expense	Advertising expense Advertising costs are expensed as incurred, which are included in sales and marketing.
Segment reporting	Segment reporting Operating segments are defined as components of an enterprise about which separate financial information is available and is evaluated on a regular basis by the chief operating decision-maker, or decision-making group, in deciding how to allocate resources to an individual segment and in assessing performance of the segment. The Company’s chief operating decision-maker is its chief executive officer. The Company’s chief executive officer reviews financial information presented on an aggregate basis for purposes of allocating resources and evaluating financial performance. The Company has one business segment and there are no segment managers who are held accountable for operations, operating results and plans for products or components below the aggregate Company level. Accordingly, in light of the Company’s current product offerings, management has determined that the primary form of internal reporting is aligned with the offering of the Conformis personalized joint replacement products and that the Company operates as one segment. See “ Note K—Segment and Geographic Data .”
Foreign currency translation and transactions	Foreign currency translation and transactions The assets and liabilities of the Company’s foreign operations are translated into U.S. dollars at current exchange rates at the balance sheet date, and income and expense items are translated at average rates of exchange prevailing during the quarter. Net translation gains and losses are recorded in Accumulated other comprehensive (loss) income. Gains and losses from foreign currency transactions denominated in foreign currencies, including intercompany balances not of a long-term investment nature, are included in the Consolidated Statements of Operations.
Income taxes	Income taxes Income taxes are accounted for under the asset and liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the consolidated financial statement carrying amounts of existing assets and liabilities and their respective tax bases, operating losses and tax credit carry forwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized as income in the period that includes the enactment date. In evaluating the need for a valuation allowance, the Company considers all reasonably available positive and negative evidence, including recent earnings, expectations of future taxable income and the character of that income. In estimating future taxable income, the Company relies upon assumptions and estimates of future activity including the reversal of temporary differences. Presently, the Company believes that a full valuation allowance is required to reduce deferred tax assets to the amount expected to be realized. The tax benefit from an uncertain tax position is only recognized if it is more likely than not that the tax position will be sustained on examination by the taxing authorities, based on the technical merits of the position. The tax benefits recognized in the consolidated financial statements from these positions are measured based on the largest benefit that has a greater than fifty percent likelihood of being realized upon ultimate resolution. The Company reviews its tax positions on an annual basis and more frequently as facts surrounding tax positions change. Based on these future events, the Company may recognize uncertain tax positions or reverse current uncertain tax positions, the impact of which would affect the consolidated financial statements. The Company has operations in Germany. The operating results of German operations will be permanently reinvested in that jurisdiction. As a result, the Company has only provided for income taxes at local rates when required. In April 2020, new interpretations of a German law related to intellectual property and withholding tax were released. The Company is currently evaluating whether the interpretations will have an impact on its consolidated financial statements. The Company is subject to U.S. federal, state, and foreign income taxes. The Company recorded a provision for income taxes of $20,000 and $21,000 for the three months ended September 30, 2020 and 2019 , respectively, and $17,000 and $35,000 for the nine months ended September 30, 2020 and 2019 , respectively. The Company recognizes interest and penalties related to income taxes as a component of income tax expense. As of September 30, 2020 and 2019 , a cumulative balance of $42,000 and $47,000 of interest and penalties had been accrued, respectively. On March 27, 2020, the U.S. government enacted the Coronavirus Aid, Relief, and Economic Security Act (the "CARES Act") which included modifications to the limitation on business interest expense, net operating loss provisions, and other various U.S. tax law updates. The Company does not expect that these aspects of the CARES Act will have a material impact on its consolidated financial statements.
Stock-based compensation	Stock-based compensation The Company accounts for stock-based compensation in accordance with ASC 718, Stock Based Compensation ("ASC 718"). ASC 718 requires all stock-based payments to employees and consultants, including grants of stock options, to be recognized in the consolidated statements of operations based on their fair values. The Company uses the Black-Scholes option pricing model to determine the weighted-average fair value of options granted and recognizes the compensation expense of stock-based awards on a straight-line basis over the vesting period of the award. The determination of the fair value of stock-based payment awards utilizing the Black-Scholes option pricing model is affected by the stock price, exercise price, and a number of assumptions, including expected volatility of the stock, expected life of the option, risk-free interest rate and expected dividends on the stock. The Company evaluates the assumptions used to value the awards at each grant date and if factors change and different assumptions are utilized, stock-based compensation expense may differ significantly from what has been recorded in the past. If there are any modifications or cancellations of the underlying unvested securities, the Company may be required to accelerate, increase or cancel any remaining unearned stock-based compensation expense.
Net loss per share	Net loss per share The Company calculates net income (loss) per share in accordance with ASC 260, "Earnings per Share." Basic earnings per share (“EPS”) is calculated by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period, without consideration for common stock equivalents. Diluted EPS is computed by dividing the net income or loss for the period by the weighted average number of common shares outstanding for the period and the weighted average number of dilutive common stock equivalents outstanding for the period determined using the treasury stock method.

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2020
Accounting Policies [Abstract]
Schedule of Cash and Cash Equivalents	The following table provides a reconciliation of cash, cash equivalents, and restricted cash reported within the consolidated balance sheets that sum to the total of the same such amounts shown in the consolidated statements of cash flows. September 30, December 31, Cash and cash equivalents $ 32,888 $ 26,394 Restricted cash 462 462 Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 33,350 $ 26,856
Contract with Customer, Asset and Liability	The following table summarizes activity for rebate allowance reserve (in thousands): September 30, 2020 December 31, 2019 Beginning Balance $ 127 $ 96 Provision related to current period sales 113 145 Adjustment related to prior period sales (1 ) 20 Payments or credits issued to customer (80 ) (134 ) Ending Balance $ 159 $ 127
Schedule of computation of basic and diluted earnings per share attributable to stockholders	The following table sets forth the computation of basic and diluted earnings per share attributable to stockholders (in thousands, except share and per share data): Three Months Ended September 30, Nine Months Ended September 30, (in thousands, except share and per share data) 2020 2019 2020 2019 Numerator: Basic and diluted loss per share Net loss $ (6,183 ) $ (8,701 ) $ (17,671 ) $ (23,045 ) Denominator: Basic and diluted weighted average shares 71,224,786 64,750,275 69,799,495 63,651,412 Loss per share attributable to Conformis, Inc. stockholders: Basic and diluted $ (0.09 ) $ (0.13 ) $ (0.25 ) $ (0.36 )
Schedule of potential shares of common stock equivalents that are antidilutive and not included in the calculation of diluted net loss per share	The following table sets forth potential shares of common stock equivalents that are not included in the calculation of diluted net loss per share because to do so would be anti-dilutive as of the end of each period presented: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Stock options and restricted stock awards 694,817 2,588,330 993,012 3,340,154

Accounts Receivable (Tables)

Accounts Receivable (Tables)	9 Months Ended
	Sep. 30, 2020
Accounts Receivable, after Allowance for Credit Loss, Current [Abstract]
Schedule of accounts receivable	Accounts receivable consisted of the following (in thousands): September 30, December 31, Total receivables $ 9,308 $ 11,401 Allowance for doubtful accounts and returns (328 ) (335 ) Accounts receivable, net $ 8,980 $ 11,066
Allowance for doubtful accounts receivable	Summary of allowance for doubtful accounts and returns activity was as follows (in thousands): September 30, December 31, Beginning balance $ (335 ) $ (390 ) Provision for bad debts on trade receivables (72 ) (106 ) Other allowances 8 (26 ) Accounts receivable write offs 71 187 Ending balance $ (328 ) $ (335 )

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2020
Inventory Disclosure [Abstract]
Schedule of inventories	Inventories consisted of the following (in thousands): September 30, December 31, Raw Material $ 6,270 $ 6,171 Work in process 1,196 1,717 Finished goods 5,443 4,186 Total Inventories $ 12,909 $ 12,074

Property and Equipment (Tables)

Property and Equipment (Tables)	9 Months Ended
	Sep. 30, 2020
Property, Plant and Equipment [Abstract]
Schedule of property and equipment	Property and equipment consisted of the following (in thousands): Estimated September 30, 2020 December 31, 2019 Equipment 5-7 $ 19,362 $ 19,011 Furniture and fixtures 5-7 864 864 Computer and software 3 9,801 9,561 Leasehold improvements 3-7 2,081 2,008 Reusable instruments 5 5,739 3,402 Total property and equipment 37,847 34,846 Accumulated depreciation (24,782 ) (21,490 ) Property and equipment, net $ 13,065 $ 13,356

Accrued Expenses (Tables)

Accrued Expenses (Tables)	9 Months Ended
	Sep. 30, 2020
Accrued Liabilities and Other Liabilities [Abstract]
Schedule of accrued expenses	Accrued expenses consisted of the following (in thousands): September 30, December 31, Accrued employee compensation $ 3,413 $ 3,198 Accrued legal expense 1,578 310 Accrued consulting expense 21 21 Accrued vendor charges 641 1,037 Accrued revenue share expense 597 1,050 Accrued clinical trial expense 251 394 Accrued other 1,221 1,125 $ 7,722 $ 7,135

Leases (Tables)

Leases (Tables)	9 Months Ended
	Sep. 30, 2020
Leases [Abstract]
Lease, Cost	The components of lease expense and related cash flows were as follows (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Rent expense $ 381 $ 381 $ 1,144 $ 1,145 Variable lease cost (1) 88 90 265 289 $ 469 $ 471 $ 1,409 $ 1,434 (1) Variable operating lease expenses consist primarily of common area maintenance and real estate taxes for the three and nine months ended September 30, 2020 and 2019 , respectively.
Lessee, Operating Lease, Liability, Maturity	The future minimum rental payments under these agreements as of September 30, 2020 were as follows (in thousands): Year Minimum Lease Payments 2020 remainder of year 406 2021 1,633 2022 1,399 2023 1,053 After 2023 1,885 Total lease payments $ 6,376 Present value adjustment (776 ) Present value of lease liabilities $ 5,600

Debt and Notes Payable (Tables)

Debt and Notes Payable (Tables)	9 Months Ended
	Sep. 30, 2020
Debt Disclosure [Abstract]
Schedule of long term debt	Long-term debt consisted of the following (in thousands): September 30, December 31, PPP "Term Loan" 4,720 — Innovatus, Term Loan 20,000 20,000 Innovatus, Term Loan accrued payment-in-kind interest 645 262 Less unamortized debt issuance costs (532 ) (639 ) Long-term debt, less debt issuance costs $ 24,833 $ 19,623
Schedule of principal payments due	Principal payments, including the Term Loan Basic Interest Rate in-kind (described below), due as of September 30, 2020 consisted of the following (in thousands): Principal Payment 2020 (remainder of the year) — 2021 — 2022 4,720 2023 8,986 2024 12,580 Total $ 26,286

Stockholders' Equity (Tables)

Stockholders' Equity (Tables)	9 Months Ended
	Sep. 30, 2020
Stockholders' Equity Note [Abstract]
Range of warrant prices per share for shares under warrants and the weighted average contractual life	At September 30, 2020 and December 31, 2019 , the weighted average warrant exercise price per share for common stock and pre-funded warrants underlying the warrants and the weighted average contractual life was as follows: Number of Common Number of Pre-funded Warrants Weighted Weighted Average Remaining Contractual Life Number of Weighted Outstanding December 31, 2019 28,926 — $ 9.80 3.66 28,926 $ 9.80 Granted 18,005,041 — $ 0.88 4.98 18,005,041 $ 0.88 Granted- pre-funded warrants — 9,492,953 $ 0.0001 — 9,492,953 $ 0.0001 Exercised — — — — — — Cancelled/expired (8,000 ) — — — (8,000 ) — Outstanding September 30, 2020 18,025,967 9,492,953 $ 0.89 4.98 27,518,920 $ 0.89
Schedule of activity under all stock option plans	Activity under all stock option plans was as follows: Number of Options Weighted Average Exercise Price per Share Aggregate Intrinsic Value (in Thousands) Outstanding December 31, 2019 1,802,463 $ 6.75 Granted 291,667 0.90 Expired (421,135 ) 7.48 Cancelled/Forfeited (12,433 ) 1.39 Outstanding September 30, 2020 1,660,562 $ 5.57 $ — Total vested and exercisable 1,260,040 $ 6.73 $ —
Schedule of restricted stock award activity under the plan	Restricted common stock award activity under the plan was as follows: Number of Shares Weighted Average Fair Value Unvested December 31, 2019 4,436,928 $ 1.54 Granted 4,166,296 0.96 Vested (1,562,132 ) 1.41 Forfeited (325,645 ) 1.19 Unvested September 30, 2020 6,715,447 $ 1.23
Assumptions used to estimate the fair value of options at date of grant	The fair value of options at date of grant was estimated using the Black-Scholes option pricing model, based on the following assumptions: Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Risk-free interest rate 0.38% 1.89% 1.14% 1.89% Expected term (in years) 6 6.00 6.16 6.00 Dividend yield —% —% —% —% Expected volatility 52.92% 55.80% 54.89% 55.80%
Summary of stock-based compensation	The following is a summary of stock-based compensation expense (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Cost of revenues $ 29 $ (23 ) $ 43 $ 276 Sales and marketing 136 (11 ) 364 119 Research and development 166 (19 ) 480 440 General and administrative 641 126 1,696 1,344 $ 972 $ 73 $ 2,583 $ 2,179

Segment and Geographic Data (Ta

Segment and Geographic Data (Tables)	9 Months Ended
	Sep. 30, 2020
Segment Reporting [Abstract]
Schedule of revenue by geographic information	Geographic information consisted of the following (in thousands): Three Months Ended September 30, Nine Months Ended September 30, 2020 2019 2020 2019 Product revenue United States $ 14,139 $ 15,144 $ 36,298 $ 49,924 Germany 1,536 1,527 4,852 5,677 Rest of world 300 441 858 1,317 $ 15,975 $ 17,112 $ 42,008 $ 56,918
Schedule of property, plant and equipment by geographic information	September 30, 2020 December 31, 2019 Property and equipment, net United States $ 13,023 $ 13,303 Germany 42 53 $ 13,065 $ 13,356

Organization and Basis of Pre_2

Organization and Basis of Presentation (Details)

Sep. 23, 2020USD ($)$ / sharesshares

Aug. 05, 2020USD ($)

May 22, 2020USD ($)

Mar. 23, 2020USD ($)

Sep. 30, 2019USD ($)milestone

Jun. 25, 2019USD ($)

Dec. 17, 2018USD ($)$ / sharesshares

May 10, 2017USD ($)

Jan. 31, 2017USD ($)

Sep. 30, 2020USD ($)$ / shares

Sep. 30, 2019USD ($)

Sep. 30, 2020USD ($)$ / sharesshares

Sep. 30, 2019USD ($)

Mar. 31, 2020USD ($)shares

Jul. 01, 2020USD ($)

Dec. 31, 2019USD ($)$ / shares

Line of Credit Facility [Line Items]

Accumulated deficit

$ (521,816,000)

$ (521,816,000)

$ (504,145,000)

Cash and cash equivalents and investments

32,900,000

32,900,000

Restricted cash

500,000

500,000

$ 500,000

Amount of equity able to raise

$ 200,000,000

$ 200,000,000

Maximum offering price

$ 50,000,000

Net proceeds from issuance of common stock

3,151,000

$ 3,000,000

Issuance of common stock

3,000,000

Total revenue

16,121,000

$ 17,303,000

$ 52,064,000

57,540,000

Registered Direct Offering

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

8,512,088

Common stock shares and warrants per unit | shares

1

Sale of stock (in usd per share) | $ / shares

$ 0.9581

Maximum percentage of common stock owned after exercise

9.99%

Proceeds received from sale of stock

$ 15,900,000

Equity Distribution Agreement

Line of Credit Facility [Line Items]

Number of shares sold (in shares) | shares

2,663,000

Net proceeds from issuance of common stock

$ 4,400,000

Cowen Sales Agreement

Line of Credit Facility [Line Items]

Amount of equity able to raise

$ 25,000,000

Broker commissions

3.00%

Innovatus

Line of Credit Facility [Line Items]

Issuance of common stock

$ 3,000,000

LPC Agreements

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

1,921,968

Proceeds received from sale of stock

$ 1,000,000

Amount of equity able to raise

$ 17,600,000

Number of shares sold (in shares) | shares

4,521,968

Net proceeds from issuance of common stock

$ 3,400,000

Premium on previous day's closing price

110.00%

Purchase period

36 months

LPC Agreements, Consideration For Commitment To Purchase Shares

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

354,430

Term loan | 2019 Secured Loan Agreement

Line of Credit Facility [Line Items]

Maximum borrowing capacity

$ 30,000,000

Minimum cash on hand

$ 5,000,000

Instrumentation Technology | Howmedica Osteonics Corp

Line of Credit Facility [Line Items]

Installment payment

$ 14,000,000

5,000,000

Potential milestone payment

$ 16,000,000

Number of potential milestones | milestone

3

Royalty and licensing

Line of Credit Facility [Line Items]

Total revenue

146,000

$ 191,000

$ 10,056,000

$ 622,000

Maximum | LPC Agreements

Line of Credit Facility [Line Items]

Value of stock to be sold

$ 20,000,000

Minimum | LPC Agreements

Line of Credit Facility [Line Items]

Sale of stock (in usd per share) | $ / shares

$ 0.25

Conformis v Zimmer Biomet | Positive Outcome of Litigation

Line of Credit Facility [Line Items]

Proceeds from legal settlements

$ 3,500,000

Total amount awarded

$ 9,600,000

Zimmer Biomet | Royalty and licensing

Line of Credit Facility [Line Items]

Total revenue

$ 9,600,000

Pre-Funded Warrants

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

9,492,953

Granted pre-funded warrants (in dollars per share) | $ / shares

$ 0.0001

Pre-Funded Warrants | Registered Direct Offering

Line of Credit Facility [Line Items]

Number of shares issued in transaction (in shares) | shares

9,492,953

Gross proceeds

$ 17,300,000

Common stock shares and warrants per unit | shares

1

Granted pre-funded warrants (in dollars per share) | $ / shares

$ 0.0001

Common stock warrants

Line of Credit Facility [Line Items]

Granted pre-funded warrants (in dollars per share) | $ / shares

$ 0.89

$ 0.89

$ 9.80

Common stock warrants | Registered Direct Offering

Line of Credit Facility [Line Items]

Granted pre-funded warrants (in dollars per share) | $ / shares

$ 0.8748

Expiration period or warrants

5 years

Summary of Significant Accoun_4

Summary of Significant Accounting Policies (Concentration Risk) (Details) - Zimmer Biomet - Customer Concentration Risk	9 Months Ended
	Sep. 30, 2020
Revenue Benchmark
Concentration Risk [Line Items]
Concentration risk percentage	18.00%
Accounts Receivable
Concentration Risk [Line Items]
Concentration risk percentage	40.00%

Summary of Significant Accoun_5

Summary of Significant Accounting Policies (Cash and Cash Equivalents, Inventories, Intangibles and Other Long-Lived Assets, and Goodwill) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Cash and cash equivalents
Cash held in foreign bank accounts	$ 1,100		$ 1,100		$ 800
Restricted cash	500		500		$ 500
Cost of revenue	8,437	$ 9,675	26,148	$ 30,459
Improper Classification of Cost of Revenue
Cash and cash equivalents
Cost of revenue	$ 400	$ 900	$ 2,100	$ 2,200

Summary of Significant Accoun_6

Summary of Significant Accounting Policies - Schedule of Cash and Cash Equivalents (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019	Jun. 30, 2019	Dec. 31, 2018
Accounting Policies [Abstract]
Cash and cash equivalents	$ 32,888	$ 26,394
Restricted cash	462	462
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows	$ 33,350	$ 26,856	$ 29,895	$ 16,842

Summary of Significant Accoun_7

Summary of Significant Accounting Policies (Leases) (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019	Jan. 01, 2019
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets	$ 4,977	$ 5,853
Operating lease liabilities	$ 5,600
Accounting Standards Update 2016-02
Lessee, Lease, Description [Line Items]
Operating lease right-of-use assets			$ 7,000
Operating lease liabilities			$ 7,700

Summary of Significant Accoun_8

Summary of Significant Accounting Policies (Revenue Recognition) (Details) - USD ($) $ in Thousands	Nov. 04, 2020	May 22, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Disaggregation of Revenue [Line Items]
Contract liability				$ 14,000		$ 14,000		$ 0
Revenue				16,121	$ 17,303	$ 52,064	$ 57,540
Minimum
Disaggregation of Revenue [Line Items]
Contract with customer payment period						30 days
Maximum
Disaggregation of Revenue [Line Items]
Contract with customer payment period						60 days
Shipping and Handling
Disaggregation of Revenue [Line Items]
Shipping and handling expense				400	300	$ 1,100	1,300
Royalty and licensing
Disaggregation of Revenue [Line Items]
Revenue				146	191	$ 10,056	622
Howmedica Osteonics Corp | Instrumentation Technology
Disaggregation of Revenue [Line Items]
Consideration			$ 30,000
Howmedica Osteonics Corp | Cost Reimbursement
Disaggregation of Revenue [Line Items]
Contract with customer asset, net			5,000		5,000		5,000
Howmedica Osteonics Corp | Royalty
Disaggregation of Revenue [Line Items]
Contract with customer asset, net			$ 25,000		$ 25,000		$ 25,000
Positive Outcome of Litigation | Conformis v Zimmer Biomet
Disaggregation of Revenue [Line Items]
Proceeds from legal settlements		$ 3,500
Total amount awarded		$ 9,600
Zimmer Biomet | Royalty and licensing
Disaggregation of Revenue [Line Items]
Revenue				$ 9,600
Subsequent Event | Zimmer Biomet | Royalty and licensing
Disaggregation of Revenue [Line Items]
Revenue	$ 8,500

Summary of Significant Accoun_9

Summary of Significant Accounting Policies Summary of Significant Accounting Policies (Rebate Reserve) (Details) - USD ($) $ in Thousands	9 Months Ended	12 Months Ended
	Sep. 30, 2020	Dec. 31, 2019
Change in Contract Liabilities
Beginning Balance	$ 127	$ 96
Provision related to current period sales	113	145
Adjustment related to prior period sales	(1)	20
Payments or credits issued to customer	(80)	(134)
Ending Balance	$ 159	$ 127

Summary of Significant Accou_10

Summary of Significant Accounting Policies (Expenses and Net Loss Per Share) (Details) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020USD ($)$ / sharesshares	Sep. 30, 2019USD ($)$ / sharesshares	Sep. 30, 2020USD ($)segment$ / sharesshares	Sep. 30, 2019USD ($)$ / sharesshares	Jun. 30, 2019USD ($)
Advertising expense
Advertising expense	$ 100	$ 200	$ 300	$ 300
Segment reporting
Number of operating segments | segment			1
Income taxes
Income tax provision	20	21	$ 17	35
Interest and penalties accrued	42		42		$ 47
Numerator for basic and diluted loss per share:
Net loss	$ (6,183)	$ (8,701)	$ (17,671)	$ (23,045)
Denominator for basic loss per share:
Basic and diluted weighted average shares | shares	71,224,786	64,750,275	69,799,495	63,651,412
Basic and diluted loss per share attributable to ConforMIS, Inc. stockholders (in dollars per share) | $ / shares	$ (0.09)	$ (0.13)	$ (0.25)	$ (0.36)

Summary of Significant Accou_11

Summary of Significant Accounting Policies (Schedule of Antidilutive Securities Excluded from Computation of Earnings Per Share) (Details) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Stock options and restricted stock awards
Antidilutive Securities Excluded from Computation of Earnings Per Share
Anti-dilutive shares not included in the calculation of diluted net loss per share (in shares)	694,817	2,588,330	993,012	3,340,154

Accounts Receivable (Schedule o

Accounts Receivable (Schedule of Accounts Receivable) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Accounts Receivable, after Allowance for Credit Loss, Current [Abstract]
Total receivables	$ 9,308		$ 9,308		$ 11,401
Allowance for doubtful accounts and returns	(328)		(328)		(335)
Accounts receivable, net	8,980		8,980		11,066
Unbilled receivable	1,400		1,400		2,100
Accounts receivable write offs	$ 0	$ 38	$ 71	$ 70	$ 187

Accounts Receivable (Allowance

Accounts Receivable (Allowance For Doubtful Accounts Receivable) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance			$ (335)	$ (390)	$ (390)
Provision for bad debts on trade receivables			(72)		(106)
Other allowances			8		(26)
Accounts receivable write offs	$ 0	$ 38	71	$ 70	187
Ending balance	$ (328)		$ (328)		$ (335)

Inventories (Details)

Inventories (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw Material	$ 6,270	$ 6,171
Work in process	1,196	1,717
Finished goods	5,443	4,186
Total Inventories	$ 12,909	$ 12,074

Property and Equipment (Details

Property and Equipment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019	Dec. 31, 2019
Property and equipment
Total property and equipment	$ 37,847		$ 37,847		$ 34,846
Accumulated depreciation	(24,782)		(24,782)		(21,490)
Property and equipment, net	13,065		13,065		13,356
Depreciation expense	1,100	$ 1,000	3,300	$ 3,100
Equipment
Property and equipment
Total property and equipment	19,362		$ 19,362		19,011
Equipment | Minimum
Property and equipment
Estimated useful life			5 years
Equipment | Maximum
Property and equipment
Estimated useful life			7 years
Furniture and fixtures
Property and equipment
Total property and equipment	864		$ 864		864
Furniture and fixtures | Minimum
Property and equipment
Estimated useful life			5 years
Furniture and fixtures | Maximum
Property and equipment
Estimated useful life			7 years
Computer and software
Property and equipment
Estimated useful life			3 years
Total property and equipment	9,801		$ 9,801		9,561
Leasehold improvements
Property and equipment
Total property and equipment	2,081		$ 2,081		2,008
Leasehold improvements | Minimum
Property and equipment
Estimated useful life			3 years
Leasehold improvements | Maximum
Property and equipment
Estimated useful life			7 years
Reusable instruments
Property and equipment
Estimated useful life			5 years
Total property and equipment	$ 5,739		$ 5,739		$ 3,402

Accrued Expenses (Details)

Accrued Expenses (Details) - USD ($) $ in Thousands	Sep. 30, 2020	Dec. 31, 2019
Accrued Liabilities and Other Liabilities [Abstract]
Accrued employee compensation	$ 3,413	$ 3,198
Accrued legal expense	1,578	310
Accrued consulting expense	21	21
Accrued vendor charges	641	1,037
Accrued revenue share expense	597	1,050
Accrued clinical trial expense	251	394
Accrued other	1,221	1,125
Total	$ 7,722	$ 7,135

Leases - Narrative (Details)

Leases - Narrative (Details)	9 Months Ended
	Sep. 30, 2020extension
Lessee, Lease, Description [Line Items]
Number of renewal options	1
Weighted average remaining lease term	4 years 4 months 17 days
Weighted average discount rate	6.00%
Billerica Facility
Lessee, Lease, Description [Line Items]
Renewal term	5 years
Minimum
Lessee, Lease, Description [Line Items]
Remaining lease term	1 year
Maximum
Lessee, Lease, Description [Line Items]
Remaining lease term	7 years

Leases - Lease Cost (Details)

Leases - Lease Cost (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Leases [Abstract]
Rent expense	$ 381	$ 381	$ 1,144	$ 1,145
Variable lease cost	88	90	265	289
Total lease cost	$ 469	$ 471	$ 1,409	$ 1,434

Leases - Schedule of Lease Matu

Leases - Schedule of Lease Maturities (Details) $ in Thousands	Sep. 30, 2020USD ($)
Leases [Abstract]
2020 remainder of year	$ 406
2021	1,633
2022	1,399
2023	1,053
After 2023	1,885
Total lease payments	6,376
Present value adjustment	(776)
Present value of lease liabilities	$ 5,600

Commitments and Contingencies (

Commitments and Contingencies (Details) $ in Thousands	Nov. 04, 2020USD ($)	May 22, 2020USD ($)	Apr. 24, 2020patent	Mar. 20, 2020patent	Nov. 05, 2019patent	Aug. 29, 2019patent	Aug. 15, 2019patent	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)
License and revenue share agreements
Total revenue | $								$ 16,121	$ 17,303	$ 52,064	$ 57,540
Revenue share agreements
License and revenue share agreements
Revenue share expense | $								$ 400	$ 600	$ 1,100	$ 1,200
Revenue share expense as a percentage of product revenues								2.70%	3.70%	2.60%	2.20%
Revenue share agreements | Members of scientific advisory board | Minimum
License and revenue share agreements
Required payment to related party from net revenues of current and planned products (as a percent)										0.10%
Revenue share agreements | Members of scientific advisory board | Maximum
License and revenue share agreements
Required payment to related party from net revenues of current and planned products (as a percent)										1.33%
Conformis v Zimmer Biomet
License and revenue share agreements
Gain contingency, patents allegedly infringed | patent							4
Conformis v Zimmer Biomet | Positive Outcome of Litigation
License and revenue share agreements
Proceeds from legal settlements | $		$ 3,500
Total amount awarded | $		$ 9,600
Zimmer Biomet v Conformis
License and revenue share agreements
Loss contingency, patents allegedly infringed | patent					5
Conformis v Medacta
License and revenue share agreements
Gain contingency, patents allegedly infringed | patent						4
Osteoplastics v Conformis
License and revenue share agreements
Loss contingency, patents allegedly infringed | patent				7
Conformis v Wright Medical
License and revenue share agreements
Gain contingency, patents allegedly infringed | patent			4
iDuo | Zimmer Biomet v Conformis
License and revenue share agreements
Loss contingency, patents allegedly infringed | patent					3
iUni | Zimmer Biomet v Conformis
License and revenue share agreements
Loss contingency, patents allegedly infringed | patent					2
Royalty and licensing
License and revenue share agreements
Total revenue | $								$ 146	$ 191	$ 10,056	$ 622
Zimmer Biomet | Royalty and licensing
License and revenue share agreements
Total revenue | $								$ 9,600
Zimmer Biomet | Subsequent Event | Royalty and licensing
License and revenue share agreements
Total revenue | $	$ 8,500

Debt and Notes Payable (Schedul

Debt and Notes Payable (Schedule of Long Term Debt) (Details) - USD ($)	6 Months Ended
	Dec. 31, 2020	Sep. 30, 2020	Dec. 31, 2019
Debt and Notes Payable
Less unamortized debt issuance costs		$ (532,000)	$ (639,000)
Long-term debt, less debt issuance costs		24,833,000	19,623,000
Principal payments due
2020 (remainder of the year)		0
2021		0
2022		4,720,000
2023		8,986,000
2024		12,580,000
Total		26,286,000
Payment Protection Plan Term Loan
Debt and Notes Payable
Term Loan principal		4,720,000	0
Innovatus Term Loan | Term loan
Debt and Notes Payable
Term Loan principal		20,000,000	20,000,000
Innovatus, Term Loan accrued payment-in-kind interest		$ 645,000	$ 262,000
Forecast | Subsequent Event | 2019 Secured Loan Agreement | Term loan
Debt and Notes Payable
Minimum gross cash proceeds	$ 20,000,000

Debt and Notes Payable (Details

Debt and Notes Payable (Details)	Jun. 25, 2019USD ($)	Jun. 30, 2017USD ($)	Dec. 31, 2020USD ($)	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Jan. 01, 2021USD ($)	Jul. 01, 2020USD ($)	Apr. 17, 2020USD ($)payment	Dec. 13, 2018USD ($)	Jan. 06, 2017USD ($)
Credit facility
Loss on extinguishment of debt				$ 0	$ (1,085,000)
Paycheck Protection Program Note
Credit facility
Interest rate stated percentage								1.00%
Debt instrument principal								$ 4,700,000
Number of payments | payment								1
2017 Secured Loan Agreement | Term loan
Credit facility
Principal amount									$ 30,000,000
Additional interest rate if event of default occurs (as a percent)	5.00%
2017 Secured Loan Agreement | Term loan | Oxford Term Loan
Credit facility
Amount drawn down		$ 15,000,000
Loss on extinguishment of debt	$ (1,100,000)
2017 Secured Loan Agreement | Term loan | Oxford Term Loan B
Credit facility
Maximum borrowing capacity										$ 15,000,000
2019 Secured Loan Agreement | Term loan
Credit facility
Maximum borrowing capacity	$ 30,000,000
Margin rate (as a percent)	3.75%
Effective interest rate				9.25%
Final payment, percent of amount of loans advanced	5.00%
Credit facility term	4 years
Interest rate stated percentage	2.50%
Event of default, threshold amount	$ 500,000
Minimum cash on hand							$ 5,000,000
2019 Secured Loan Agreement | Term loan | Prime Rate
Credit facility
Margin rate (as a percent)	5.50%
2019 Secured Loan Agreement | Revolving Credit Facility
Credit facility
Maximum borrowing capacity	$ 10,000,000
Principal amount				$ 0
Margin rate (as a percent)	0.50%
Percent of eligible accounts subject to maximum 2.50% dilution	85.00%
2019 Secured Loan Agreement | Revolving Credit Facility | Prime Rate
Credit facility
Margin rate (as a percent)	5.50%
Minimum | 2017 Secured Loan Agreement | Term loan | Oxford Term Loan
Credit facility
Cash collateral requirement									$ 5,000,000
Minimum | 2019 Secured Loan Agreement | Term loan
Credit facility
Event of default, threshold amount	$ 250,000
Forecast | Subsequent Event | 2019 Secured Loan Agreement | Term loan
Credit facility
Minimum cash on hand						$ 10,000,000
Minimum gross cash proceeds			$ 20,000,000

Stockholders' Equity (Common St

Stockholders' Equity (Common Stock) (Details)	Sep. 30, 2020USD ($)
Stockholders' Equity Note [Abstract]
Common stock dividends declared to date	$ 0

Stockholders' Equity (Preferred

Stockholders' Equity (Preferred Stock) (Details) - $ / shares	Jun. 25, 2019	Sep. 30, 2020	Dec. 31, 2019
Stockholders' Equity Note [Abstract]
Preferred stock, shares authorized		5,000,000	5,000,000
Preferred stock, par value (in dollars per share)		$ 0.00001	$ 0.00001
Preferred stock, shares issued		0	0
Preferred stock, shares outstanding		0	0
2019 Rights Agreement
Class of Stock [Line Items]
Maximum days to register for resale shares held by investors	120 days

Stockholders' Equity Stockholde

Stockholders' Equity Stockholders' Equity (Registered Direct Offering) (Details) - USD ($) $ / shares in Units, $ in Millions	Sep. 23, 2020	Sep. 30, 2020	Dec. 31, 2019
Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares)	9,492,953
Exercise price of warrants or rights (in dollars per shre)	$ 0.0001
Common stock warrants
Class of Warrant or Right [Line Items]
Exercise price of warrants or rights (in dollars per shre)		$ 0.89	$ 9.80
Registered Direct Offering
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares)	8,512,088
Common stock shares and warrants per unit	1
Sale of stock (in usd per share)	$ 0.9581
Maximum percentage of common stock owned after exercise	9.99%
Proceeds received from sale of stock	$ 15.9
Registered Direct Offering | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares)	9,492,953
Gross proceeds	$ 17.3
Common stock shares and warrants per unit	1
Exercise price of warrants or rights (in dollars per shre)	$ 0.0001
Registered Direct Offering | Common stock warrants
Class of Warrant or Right [Line Items]
Exercise price of warrants or rights (in dollars per shre)	$ 0.8748
Expiration period or warrants	5 years

Stockholders' Equity Stockhol_2

Stockholders' Equity Stockholders' Equity (Warrants) (Details) $ in Millions	Sep. 23, 2020USD ($)$ / sharesshares	Sep. 30, 2020$ / sharesshares	Dec. 31, 2019$ / shares
Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares) | shares	9,492,953
Exercise price of warrants or rights (in dollars per shre)	$ 0.0001
Warrant granted during period (in shares) | shares	18,005,041	9,492,953
Warrants and rights outstanding, term	5 years
Fair value of the common stock warrants | $	$ 10.2
Common stock warrants
Class of Warrant or Right [Line Items]
Exercise price of warrants or rights (in dollars per shre)		$ 0.89	$ 9.80
Warrant granted during period (in shares) | shares		18,005,041
Expected Term | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input term	5 years
Risk Free Interest Rate | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input	0.0028
Dividend Yield | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input	0
Volatility | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input	0.9015
Exercise Price | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input	0.875
Share Price | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Warrants, measurement input	0.833
Registered Direct Offering
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares) | shares	8,512,088
Registered Direct Offering | Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Number of shares issued in transaction (in shares) | shares	9,492,953
Exercise price of warrants or rights (in dollars per shre)	$ 0.0001
Registered Direct Offering | Common stock warrants
Class of Warrant or Right [Line Items]
Exercise price of warrants or rights (in dollars per shre)	$ 0.8748

Stockholders' Equity (Warrants

Stockholders' Equity (Warrants and Common Stock Warrants) (Details) - $ / shares	Sep. 23, 2020	Sep. 30, 2020	Dec. 31, 2019
Common stock warrants
Class of Warrant or Right [Line Items]
Number of warrants, outstanding (in shares)		18,025,967	28,926
Number of Warrants
Outstanding at beginning of period (in shares)		28,926
Granted (in shares)		18,005,041
Exercised (in shares)		0
Cancelled/expired (in shares)		8,000
Outstanding at end of period (in shares)		18,025,967	28,926
Weighted Average Exercise Price Per Share
Outstanding at beginning of period (in dollars per share)		$ 9.80
Granted (in dollars per share)		0.88
Exercised (in dollars per share)		0
Cancelled/expired (in dollars per share)		0
Outstanding at end of period (in dollars per share)		$ 0.89	$ 9.80
Weighted Average Remaining Contractual Life
Weighted average remaining contractual life, outstanding (in years)		4 years 11 months 23 days	3 years 7 months 28 days
Weighted average remaining contractual life, granted (in years)		4 years 11 months 23 days
Number of Warrants Exercisable
Outstanding at beginning of period (in shares)		28,926
Granted (in shares)		18,005,041
Exercised (in share)		0
Cancelled/expired (in share)		8,000
Outstanding at end of period (in shares)		27,518,920	28,926
Weighted Average Price Per Share
Outstanding at beginning of period (in dollars per share)		$ 0.89	$ 9.80
Granted (in dollars per share)		0.88
Exercised (in dollars per share)		0
Cancelled/expired (in dollars per share)		0
Outstanding at end of period (in dollars per share)		$ 0.89	$ 9.80
Pre-Funded Warrants
Class of Warrant or Right [Line Items]
Number of warrants, outstanding (in shares)		9,492,953	0
Number of Warrants
Outstanding at beginning of period (in shares)		0
Granted - pre-fund warrants (in shares)		9,492,953
Exercised (in shares)		0
Cancelled/expired (in shares)		0
Outstanding at end of period (in shares)		9,492,953	0
Weighted Average Exercise Price Per Share
Granted (in dollars per share)		$ 0.0001
Outstanding at end of period (in dollars per share)	$ 0.0001
Number of Warrants Exercisable
Granted (in shares)	18,005,041	9,492,953
Weighted Average Price Per Share
Granted (in dollars per share)		$ 0.0001

Stockholders' Equity (Stock Opt

Stockholders' Equity (Stock Option Plans) (Details) - USD ($) $ / shares in Units, $ in Thousands	Apr. 29, 2019	Aug. 31, 2020	Feb. 29, 2020	Sep. 30, 2020	Sep. 30, 2020	Jan. 01, 2020
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested and Expected to Vest [Abstract]
Weighted average grant date fair value, vested				$ 100	$ 400
Weighted average remaining contractual term, outstanding					5 years 2 months 5 days
Weighted average remaining contractual term, vested and exercisable					3 years 11 months 27 days
Stock options
Number of Options
Balance outstanding at the beginning of the period (in shares)					1,802,463
Granted (in shares)					291,667
Expired (in shares)					(421,135)
Cancelled/Forfeited (in shares)					12,433
Balance outstanding at the end of the period (in shares)				1,660,562	1,660,562
Total vested and exercisable (in shares)				1,260,040	1,260,040
Weighted Average Exercise Price per Share
Balance at the beginning of the period (in dollars per share)					$ 6.75
Granted (in dollars per share)					0.90
Expired (in dollars per share)					7.48
Cancelled/Forfeited (in dollars per share)					1.39
Balance at the end of the period (in dollars per share)				$ 5.57	5.57
Total vested and exercisable (in dollars per share)				$ 6.73	$ 6.73
Aggregate Intrinsic Value (in Thousands)
Outstanding at end of the period				$ 0	$ 0
Total vested and exercisable				0	0
Restricted stock awards
Share-based Compensation Arrangement by Share-based Payment Award, Options, Vested and Expected to Vest [Abstract]
Weighted average grant date fair value, vested				$ 400	$ 2,200
Number of Shares
Unvested beginning of period (in shares)					4,436,928
Granted (in shares)					4,166,296
Vested (in shares)					(1,562,132)
Forfeited (in shares)					(325,645)
Unvested end of period (in shares)				6,715,447	6,715,447
Weighted Average Fair Value
Unvested beginning of period (in dollars per share)					$ 1.54
Granted (in dollars per share)					0.96
Vested (in dollars per share)					1.41
Forfeited (in dollars per share)					1.19
Unvested end of period (in dollars per share)				$ 1.23	$ 1.23
2015 Plan
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Common stock available for future issuance (in shares)				278,010	278,010
Additional shares authorized, maximum annual amount (in shares)				3,000,000	3,000,000	2,112,822
Additional shares authorized, maximum annual percentage				3.00%	3.00%
2019 Sales Team Plan | Common Stock
Share-based Compensation Arrangement by Share-based Payment Award [Line Items]
Number of shares authorized (in shares)	3,000,000
Award expiration period	10 years
Number of Shares
Unvested end of period (in shares)				2,756,481	2,756,481
Chief Financial Officer | Restricted stock awards
Number of Shares
Granted (in shares)			125,000
Chief Financial Officer | Inducement Award [Member]
Number of Options
Granted (in shares)			125,000
Weighted Average Exercise Price per Share
Granted (in dollars per share)			$ 0.98
Senior Vice President, Operations | Restricted stock awards
Number of Shares
Granted (in shares)			61,350
Senior Vice President, Operations | Inducement Award [Member]
Number of Options
Granted (in shares)			66,667
Weighted Average Exercise Price per Share
Granted (in dollars per share)			$ 0.98
Vice President, US Marketing | Restricted stock awards
Number of Shares
Granted (in shares)		100,000
Vice President, US Marketing | Inducement Award [Member]
Number of Options
Granted (in shares)		100,000
Weighted Average Exercise Price per Share
Granted (in dollars per share)		$ 0.7427

Stockholders' Equity (Stock-bas

Stockholders' Equity (Stock-based Compensation) (Details)	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Assumptions used to estimate the fair value of options at date of grant
Risk-free interest rate	0.375%	1.89%	1.14%	1.89%
Expected term (in years)	6 years	6 years	6 years 1 month 28 days	6 years
Dividend yield	0.00%	0.00%	0.00%	0.00%
Expected volatility	52.92%	55.80%	54.89%	55.80%

Stockholders' Equity (Stock-b_2

Stockholders' Equity (Stock-based Compensation Narrative) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based compensation
Weighted average grant date fair value, vested	$ 100		$ 400
Stock-based compensation expense	972	$ 73	2,583	$ 2,179
Stock options
Share-based compensation
Unrecognized compensation expense	400		$ 400
Period for unrecognized compensation expense to be recognized			2 years 6 months 15 days
Restricted stock awards
Share-based compensation
Weighted average grant date fair value, vested	400		$ 2,200
Unrecognized compensation expense	$ 6,500		$ 6,500
Period for unrecognized compensation expense to be recognized			2 years 6 months 29 days

Stockholders' Equity (Summary o

Stockholders' Equity (Summary of Stock-based Compensation) (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020	Sep. 30, 2019	Sep. 30, 2020	Sep. 30, 2019
Share-based compensation
Stock-based compensation expense	$ 972	$ 73	$ 2,583	$ 2,179
Cost of revenues
Share-based compensation
Stock-based compensation expense	29	(23)	43	276
Sales and marketing
Share-based compensation
Stock-based compensation expense	136	(11)	364	119
Research and development
Share-based compensation
Stock-based compensation expense	166	(19)	480	440
General and administrative
Share-based compensation
Stock-based compensation expense	$ 641	$ 126	$ 1,696	$ 1,344

Segment and Geographic Data (De

Segment and Geographic Data (Details) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2020USD ($)	Sep. 30, 2019USD ($)	Sep. 30, 2020USD ($)segment	Sep. 30, 2019USD ($)	Dec. 31, 2019USD ($)
Segment Reporting [Abstract]
Number of reportable segments | segment			1
Geographic information for Product Revenue and Property and equipment, net
Revenue	$ 16,121	$ 17,303	$ 52,064	$ 57,540
Property and equipment, net	13,065		13,065		$ 13,356
United States
Geographic information for Product Revenue and Property and equipment, net
Property and equipment, net	13,023		13,023		13,303
Germany
Geographic information for Product Revenue and Property and equipment, net
Property and equipment, net	42		42		$ 53
Product
Geographic information for Product Revenue and Property and equipment, net
Revenue	15,975	17,112	42,008	56,918
Product | United States
Geographic information for Product Revenue and Property and equipment, net
Revenue	14,139	15,144	36,298	49,924
Product | Germany
Geographic information for Product Revenue and Property and equipment, net
Revenue	1,536	1,527	4,852	5,677
Product | Rest of World
Geographic information for Product Revenue and Property and equipment, net
Revenue	$ 300	$ 441	$ 858	$ 1,317