Xtant Medical (XTNT) 10-Q 7 May 20 2020 Q1 Quarterly report Financial data

Document and Entity Information

Document and Entity Information - shares	3 Months Ended
	Mar. 31, 2020	May 05, 2020
Document And Entity Information
Entity Registrant Name	Xtant Medical Holdings, Inc.
Entity Central Index Key	0001453593
Document Type	10-Q
Document Period End Date	Mar. 31, 2020
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Non-accelerated Filer
Entity Small Business Flag	true
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		13,223,565
Document Fiscal Period Focus	Q1
Document Fiscal Year Focus	2020

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Current Assets:
Cash and cash equivalents	$ 3,239	$ 5,237
Trade accounts receivable, net of allowance for credit losses of $668 and doubtful accounts of $500, respectively	9,743	10,124
Inventories	18,044	16,101
Prepaid and other current assets	1,084	784
Total current assets	32,110	32,246
Property and equipment, net	4,303	4,695
Right-of-use asset, net	1,999	2,100
Goodwill	3,205	3,205
Intangible assets, net	500	515
Other assets	434	394
Total Assets	42,551	43,155
Current Liabilities:
Accounts payable	3,609	2,188
Accrued liabilities	5,910	6,625
Warrant derivative liability	1	7
Current portion of lease liability	401	394
Current portion of financing lease obligations	138	176
Total current liabilities	10,059	9,390
Long-term Liabilities:
Lease liability, less current portion	1,623	1,726
Long-term debt, less issuance costs	77,345	76,244
Total Liabilities	89,027	87,360
Commitments and Contingencies (note 11)
Stockholders' Equity (Deficit):
Preferred stock, $0.000001 par value; 10,000,000 shares authorized; no shares issued and outstanding
Common stock, $0.000001 par value; 75,000,000 shares authorized; 13,223,565 shares issued and outstanding as of March 31, 2020 and 13,161,762 shares issued and outstanding as of December 31, 2019
Additional paid-in capital	179,330	179,061
Accumulated deficit	(225,806)	(223,266)
Total Stockholders' Equity (Deficit)	(46,476)	(44,205)
Total Liabilities & Stockholders' Equity (Deficit)	$ 42,551	$ 43,155

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Statement of Financial Position [Abstract]
Trade accounts receivable, allowance for doubtful accounts	$ 668	$ 500
Preferred stock, par value	$ 0.000001	$ 0.000001
Preferred stock, shares authorized	10,000,000	10,000,000
Preferred stock, shares issued
Preferred stock, shares outstanding
Common stock, par value	$ 0.000001	$ 0.000001
Common stock, shares authorized	75,000,000	75,000,000
Common stock, shares issued	13,223,565	13,161,762
Common Stock, shares outstanding	13,223,565	13,161,762

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Revenue
Orthopedic product sales	$ 14,735	$ 16,686
Other revenue	43	40
Total Revenue	14,778	16,726
Cost of sales	5,165	5,913
Gross Profit	9,613	10,813
Operating Expenses
General and administrative	4,319	4,477
Sales and marketing	6,413	6,742
Research and development	245	262
Total Operating Expenses	10,977	11,481
Loss from Operations	(1,364)	(668)
Other (Expense) Income
Interest expense	(1,108)	(2,018)
Change in warrant derivative liability	6	(15)
Other (expense) income	(5)	(75)
Total Other (Expense)	(1,107)	(2,108)
Net Loss Before Provision for Income Taxes	(2,471)	(2,776)
Provision for income taxes	(22)	(23)
Net Loss	$ (2,493)	$ (2,799)
Net loss per share:
Basic	$ (0.19)	$ (0.21)
Dilutive	$ (0.19)	$ (0.21)
Shares used in the computation:
Basic	13,175,345	13,170,721
Dilutive	13,175,345	13,170,721

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands	Common Stock [Member]	Additional Paid-In Capital [Member]	Retained Deficit [Member]	Total
Beginning Balance at Dec. 31, 2018		$ 171,273	$ (215,045)	$ (43,772)
Beginning Balance, Shares at Dec. 31, 2018	13,172,179
Stock-based compensation		122		122
Forfeiture of restricted stock
Forfeiture of restricted stock, shares	(10,417)
Debt extinguishment		7,264		7,264
Issuance of warrant		9		9
Net loss			(2,799)	(2,799)
Ending Balance at Mar. 31, 2019		178,668	(217,844)	(39,176)
Ending Balance, Shares at Mar. 31, 2019	13,161,762
Beginning Balance at Dec. 31, 2019		179,061	(223,266)	(44,205)
Beginning Balance, Shares at Dec. 31, 2019	13,161,762
Stock-based compensation		269		269
ASU 2016-13 cumulative effect adjustment			(47)	(47)
Common stock issued on vesting of restricted stock units
Common stock issued on vesting of restricted stock units, shares	61,803
Net loss			(2,493)	(2,493)
Ending Balance at Mar. 31, 2020		$ 179,330	$ (225,806)	$ (46,476)
Ending Balance, Shares at Mar. 31, 2020	13,223,565

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Operating activities:
Net loss	$ (2,493)	$ (2,799)
Adjustments to reconcile net loss to net cash provided by operating activities:
Depreciation and amortization	685	776
(Gain) loss on disposal of fixed assets	(105)	116
Non-cash interest	1,101	1,991
Non-cash rent	4
Stock-based compensation	269	122
Provision for reserve on accounts receivable	138	94
Provision for excess and obsolete inventory	31	153
Change in warrant derivative liability	(6)	15
Changes in operating assets and liabilities:
Accounts receivable	195	403
Inventories	(1,974)	623
Prepaid and other assets	(340)	146
Accounts payable	1,421	(429)
Accrued liabilities	(715)	(721)
Net cash (used in) provided by operating activities	(1,789)	490
Investing activities:
Purchases of property and equipment and intangible assets	(258)	(137)
Proceeds from sale of fixed assets	83	51
Net cash used in investing activities	(175)	(86)
Financing activities:
Payments on financing leases	(34)	(104)
Net cash used in financing activities	(34)	(104)
Net change in cash and cash equivalents	(1,998)	300
Cash and cash equivalents at beginning of period	5,237	6,797
Cash and cash equivalents at end of period	$ 3,239	$ 7,097

Business Description, Basis of

Business Description, Basis of Presentation and Summary of Significant Accounting Policies	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Business Description, Basis of Presentation and Summary of Significant Accounting Policies	(1) Business Description, Basis of Presentation and Summary of Significant Accounting Policies Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we”, “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. The accompanying condensed consolidated balance sheet as of December 31, 2019, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2020. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2019. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation. Reclassifications Certain prior year amounts have been reclassified to conform with current year presentation. Recent Accounting Pronouncements In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments–Credit Losses: Measurement of Credit Losses on Financial Instruments Although there are several other new accounting pronouncements issued or proposed by the FASB, which the Company has adopted or will adopt, as applicable, the Company does not believe any of these accounting pronouncements has had or will have a material impact on the Company’s consolidated financial position or operating results. Use of Estimates The preparation of the consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term right-of-use asset, evaluation of ability to continue as a going concern and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates. Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. The Company looks primarily to estimated undiscounted future cash flows in its assessment of whether or not long-lived assets are recoverable. As a result of the revenue decline related to the current global novel strain of coronavirus, or COVID-19 pandemic, the Company evaluated whether the carrying values of the long-lived assets were recoverable. Based on these evaluations, the Company determined that the long-lived assets were still recoverable. No impairments of long-lived assets were recorded for the three months ended March 31, 2020 and 2019. Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually, and whenever events or circumstances indicate, the carrying amount of the asset may not be recoverable. As a result of the current COVID-19 pandemic and its impact on the Company’s projected cash flows, the Company tested goodwill for impairment at the end of the first quarter of 2020. No impairments of goodwill were recorded for the three months ended March 31, 2020 and 2019. Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three months ended March 31, 2020 and 2019, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported, as the effects of including 4,363,089 and 1,912,567 outstanding stock options, restricted stock units and warrants for the three months ended March 31, 2020 and 2019, respectively, are anti-dilutive. Fair Value of Financial Instruments As of March 31, 2020 and December 31, 2019, the fair value of the Company’s warrant derivative liability was not material. The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us. The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of March 31, 2020 and December 31, 2019.

Revenue

Revenue	3 Months Ended
	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
Revenue	(2) Revenue In the United States, we generate most of our revenue from independent commissioned sales agents. We consign our orthobiologics products to hospitals and consign or loan our spinal implant sets to the independent sales agents. The spinal implant sets typically contain the instruments, disposables, and spinal implants required to complete a surgery. Consigned sets are managed by the sales agent to service hospitals that are high volume users for multiple procedures. We ship replacement inventory to independent sales agents to replace the consigned inventory used in surgeries. Loaned sets are returned to the Company’s distribution center, replenished, and made available to sales agents for the next surgical procedure. For each surgical procedure, the sales agent reports use of the product by the hospital and, as soon as practicable thereafter, ensures that the hospital provides a purchase order to the Company. Upon receipt of the hospital purchase order, the Company invoices the hospital, and revenue is recognized in the proper period. Additionally, the Company sells product directly to domestic and international stocking resellers and private label resellers. Upon receipt and acceptance of a purchase order from a stocking reseller, the Company ships product and invoices the reseller. The Company recognizes revenue control of the promised goods is transferred to the customer, in an amount that reflects the consideration we expect to collect in exchange for those goods or services The Company operates in one reportable segment with our net revenue derived primarily from the sale of orthobiologics and spinal implant products across North America, Europe, Asia Pacific, and Latin America. Sales are reported net of returns. The following table presents revenues from these product lines for the three months ended March 31, 2020 and 2019 (in thousands): Three Months Percentage of Three Months Percentage of March 31, 2020 Total Revenue March 31, 2019 Total Revenue Orthobiologics $ 10,755 73 % $ 12,058 72 % Spinal implant 3,980 27 % 4,628 28 % Other revenue 43 0 % 40 0 % Total revenue $ 14,778 100 % $ 16,726 100 %

Receivables

Receivables	3 Months Ended
	Mar. 31, 2020
Credit Loss [Abstract]
Receivables	(3) Receivables Concurrent with the adoption of ASU 2016-13, the Company’s allowance for doubtful accounts was expanded to include provision for current expected credit loss (“CECL”). The Company’s provision for CECL is determined based on historical collection experience adjusted for current economic conditions affecting collectability. Actual customer collections could differ from estimates. Account balances are charged to the allowance after all means of collection have been exhausted and the potential for recovery is considered remote. Provisions to the allowance for credit losses are charged to expense. Activity within the allowance for credit losses was as follows for the three months ended March 31, 2020 (in thousands): Balance at January 1, 2020 $ 547 Provision for expected credit losses 138 Write-offs charged against allowance (17 ) Balance at March 31, 2020 $ 668

Inventories

Inventories	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Inventories	(4) Inventories Inventories consist of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 4,022 $ 3,805 Work in process 2,853 1,603 Finished goods 22,423 22,135 Gross inventories 29,298 27,543 Reserve for obsolescence (11,254 ) (11,442 ) Total $ 18,044 $ 16,101

Property and Equipment, Net

Property and Equipment, Net	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Property and Equipment, Net	(5) Property and Equipment, Net Property and equipment, net are as follows (in thousands): March 31, 2020 December 31, 2019 Equipment $ 4,361 $ 4,250 Computer equipment 476 455 Computer software 570 570 Furniture and fixtures 133 124 Leasehold improvements 3,980 3,980 Vehicles 10 10 Surgical instruments 10,960 10,897 Total cost 20,490 20,286 Less: accumulated depreciation (16,187 ) (15,591 ) Property and equipment, net $ 4,303 $ 4,695 Depreciation expense related to property and equipment, including property under capital lease, for the first three months of 2020 and 2019 was $0.7 million and $0.8 million, respectively. The Company leases certain equipment under finance leases. For financial reporting purposes, minimum lease payments relating to the assets have been capitalized. As of March 31, 2020, the Company has recorded $1.4 million of gross assets in equipment and $1.0 million of accumulated depreciation.

Intangible Assets

Intangible Assets	3 Months Ended
	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Intangible Assets	(6) Intangible Assets The following table sets forth information regarding intangible assets (in thousands): March 31, 2020 December 31, 2019 Patents $ 847 $ 847 Accumulated amortization (347 ) (332 ) Intangible assets, net $ 500 $ 515 The following is a summary of estimated future amortization expense for intangible assets as of March 31, 2020 (in thousands): Remainder of 2020 $ 42 2021 55 2022 54 2023 53 2024 52 Thereafter 244 Total $ 500

Accrued Liabilities

Accrued Liabilities	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Accrued Liabilities	(7) Accrued Liabilities Accrued liabilities consist of the following (in thousands): March 31, 2020 December 31, 2019 Wages/commissions payable $ 2,313 $ 3,902 Other accrued liabilities 3,597 2,723 Accrued liabilities $ 5,910 $ 6,625

Debt

Debt	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Debt	(8) Debt The Company has a credit facility with OrbiMed Royalty Opportunities II, LP (“Royalty Opportunities”) and ROS Acquisition Offshore LP (“ROS” and together with Royalty Opportunities the “Lenders”) (the “Second Amended and Restated Credit Agreement”). As of March 31, 2020, the Company had availability for additional delayed draw loan advances of $2.2 million, subject to Lenders’ discretion. In addition, the Company may request additional term loans from the Lenders in an aggregate amount up to $10.0 million, subject to Lenders’ discretion. Beginning April 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Credit Agreement at a rate per annum equal to the sum of (a) 10.00% plus (b) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%. Long-term debt consists of the following (in thousands): March 31, 2020 December 31, 2019 Amounts due under the Second Amended and Restated Credit Agreement $ 72,657 $ 72,657 PIK interest payable related to Second Amended and Restated Credit Agreement 4,229 3,280 Plus: 2% exit fee on prior credit agreement 533 399 Gross long-term debt 77,419 76,336 Less: total debt issuance costs on Credit Agreements (74 ) (92 ) Long-term debt, less issuance costs $ 77,345 $ 76,244 Amounts due under the Second Amended and Restated Credit Agreement were scheduled to mature on March 31, 2021 and become payable at that time. On May 6, 2020, the Company, entered into a First Amendment to the Second Amended and Restated Credit Agreement with the Lenders, which among other things, provided that: ● No interest will accrue on the outstanding loans under the Second Amended and Restated Credit Agreement (the “Loans”) from and after March 31, 2020 until September 30, 2020; ● Beginning October 1, 2020 through the maturity date of the Second A&R Credit Agreement, interest payable in cash will accrue on the Loans under the Second A&R Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second A&R Credit Agreement) and (y) 2.3125%; ● The maturity date of the Loans is December 31, 2021; ● The Revenue Base financial covenant was revised through December 31, 2021; and ● The key person event default provision was revised to refer specifically to Sean Browne in lieu of Ron Berlin. On May 6, 2020 Xtant issued warrants to purchase an aggregate of 2,400,000 shares of Company common stock to the Lenders, with an exercise price of $0.01 per share and an expiration date of May 6, 2030 (collectively, the “2020 Warrants”). The issuance of the 2020 Warrants was a condition to the effectiveness of the First Amendment. The number of shares of Company common stock issuable upon exercise of the 2020 Warrants are subject to standard and customary anti-dilution provisions for stock splits, stock dividends or similar transactions. The Lenders, which collectively own approximately 70% of the Company’s outstanding common stock, and beneficially own, with their warrants, approximately 75% of the Company’s common stock, are the sole holders of the Company’s outstanding long-term debt. In addition, as described in more detail in the Company’s Annual Report on Form 10-K for the year ended December 31, 2019 filed with the SEC on March 5, 2020, the Company is a party to an Investor Rights Agreement and Registration Rights Agreement with the Lenders in addition to the Second Amended and Restated Credit Agreement.

Stock-Based Compensation

Stock-Based Compensation	3 Months Ended
	Mar. 31, 2020
Share-based Payment Arrangement [Abstract]
Stock-Based Compensation	(9) Stock-Based Compensation Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan , was as follows: 2020 2019 Shares Weighted Weighted Shares Weighted Weighted Outstanding at January 1 602,966 $ 6.07 $ 3.99 496,958 $ 9.90 $ 6.62 Granted - $ - $ - 100,000 $ 2.24 $ 1.95 Cancelled or expired (76,299 ) $ 4.18 $ 2.96 (395,000 ) $ 4.71 $ 3.69 Outstanding at March 31 526,667 $ 6.34 $ 4.14 201,958 $ 10.62 $ 6.74 Exercisable at March 31 48,764 $ 41.11 $ 23.34 71,249 $ 24.35 $ 14.09 During the three months ended March 31, 2020, 489,437 restricted stock units were granted under the 2018 Plan, which vest over a weighted average period of 1.5 years.

Warrants

Warrants	3 Months Ended
	Mar. 31, 2020
Warrants and Rights Note Disclosure [Abstract]
Warrants	(10) Warrants As of March 31, 2020 and December 31, 2019, warrants for the purchase of an aggregate of 2,908,874 shares of common stock were outstanding, with a weighted average exercise price of $4.16 per share. Among these, warrants to purchase an aggregate of 87,509 shares were accounted for as a derivative liability (see Note 1).

Commitments and Contingencies

Commitments and Contingencies	3 Months Ended
	Mar. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	(11) Commitments and Contingencies Operating Leases We lease three office facilities as of March 31, 2020 in Belgrade, Montana under non-cancelable operating lease agreements with expiration dates between 2023 and 2025. We have the option to extend certain leases to five or ten-year term(s), and we have the right of first refusal on any sale. Present Value of Long-term Leases (in thousands): March 31, 2020 Right-of-use assets, net $ 1,999 Current portion of lease liability 401 Lease liability, less current portion 1,623 Total lease liability $ 2,024 As of March 31, 2020, the weighted-average remaining lease term was 4.6 years. The Company’s lease agreements do not provide a readily determinable implicit rate nor is it available to the Company from its lessors. Instead, as of March 31, 2019, the Company estimates the weighted-average discount rate for its operating leases to be 5.2% of present value based on the incremental borrowing rate. Future minimum payments for the next five years and thereafter as of March 31, 2020 under these long-term operating leases are as follows (in thousands): Remainder of 2020 $ 376 2021 507 2022 521 2023 489 2024 224 Thereafter 179 Total future minimum lease payments 2,296 Less amount representing interest (272 ) Present value of obligations under operating leases 2,024 Less current portion (401 ) Long-term operating lease obligations $ 1,623 Rent expense was $0.1 million for the three months ended March 31, 2020 and 2019. We have no contingent rent agreements. Financing Leases Future minimum payments under finance leases are as follows as of March 31, 2020 (in thousands): Remainder of 2020 $ 144 Less amount representing interest (6 ) Present value of obligations under financing leases $ 138 Litigation On December 13, 2018, a complaint was filed by RSB Spine, LLC, against Xtant Medical Holdings, Inc., which claims that some of our products, including the Irix-A Lumbar Integrated Fusion System and the Irix-C Cervical Integrated Fusion System, infringe certain of RSB Spine’s patents. On February 28, 2020, we entered into a confidential settlement and patent license agreement with RSB Spine pursuant to which we agreed to make an undisclosed settlement payment to RSB Spine and pay royalties on future sales of the two products through the expiration of the asserted patents. The settlement payment was included in accrued expenses as of December 31, 2019. In addition, we are subject to potential liabilities under government regulations and various claims and legal actions that are pending or may be asserted from time to time. These matters arise in the ordinary course and conduct of our business and may include, for example, commercial, product liability, intellectual property, and employment matters. We intend to continue to defend the Company vigorously in such matters and, when warranted, take legal action against others. Furthermore, we regularly assess contingencies to determine the degree of probability and range of possible loss for potential accrual in our financial statements. An estimated loss contingency is accrued in our financial statements if it is probable that a liability has been incurred and the amount of the loss can be reasonably estimated. Based on our assessment, we have adequately accrued an amount for contingent liabilities currently in existence. We do not accrue amounts for liabilities that we do not believe are probable or that we consider immaterial to our overall financial position. Litigation is inherently unpredictable, and unfavorable resolutions could occur. As a result, assessing contingencies is highly subjective and requires judgment about future events. The amount of ultimate loss may exceed the Company’s current accruals, and it is possible that its cash flows or results of operations could be materially affected in any particular period by the unfavorable resolution of one or more of these contingencies. Indemnifications Our indemnification arrangements generally include limited warranties and certain provisions for indemnifying customers against liabilities if our products or services infringe a third-party’s intellectual property rights. To date, we have not incurred any material costs as a result of such warranties or indemnification provisions and have not accrued any liabilities related to such obligations in the accompanying condensed consolidated financial statements. We have also agreed to indemnify our directors and executive officers for costs associated with any fees, expenses, judgments, fines, and settlement amounts incurred by any of these persons in any action or proceeding to which any of those persons is, or is threatened to be, made a party by reason of the person’s service as a director or officer, including any action by us, arising out of that person’s services as our director or officer or that person’s services provided to any other company or enterprise at our request.

Income Taxes

Income Taxes	3 Months Ended
	Mar. 31, 2020
Income Tax Disclosure [Abstract]
Income Taxes	(12) Income Taxes In evaluating the realizability of the net deferred tax assets, we take into account a number of factors, primarily relating to the ability to generate taxable income. Where it is determined that it is likely that we will be unable to realize deferred tax assets, a valuation allowance is established against the portion of the deferred tax asset. Because it cannot be accurately determined when or if we will become profitable, a valuation allowance was provided against the entire deferred income tax asset balance. The Company did not recognize any interest or penalties related to income taxes for the three months ended March 31, 2020 and 2019.

Supplemental Disclosure of Cash

Supplemental Disclosure of Cash Flow Information	3 Months Ended
	Mar. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Supplemental Disclosure of Cash Flow Information	(13) Supplemental Disclosure of Cash Flow Information Supplemental cash flow information is as follows (in thousands): Three Months Ended March 31, 2020 2019 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 7 $ 27 Non-cash activities: ASU 2016-13 cumulative effect adjustment $ 47 $ — Lease liability from right-of-use assets $ — $ 2,658 Extinguishment of Prior Credit Agreement (including debt issuance costs) $ — $ 307 Recognition of Second Amended and Restated Credit Agreement $ — $ 72,657 Recognition of 2019 Warrants $ — $ 9

Related Party Transactions

Related Party Transactions	3 Months Ended
	Mar. 31, 2020
Related Party Transactions [Abstract]
Related Party Transactions	(14) Related Party Transactions Royalty Opportunities and ROS collectively own approximately 70% of the Company’s outstanding common stock and are the sole holders of our outstanding long-term debt and are Lenders under the Second A&R Credit Agreement. In addition, as described in more detail under Note 1, “ Business Description and Summary of Significant Accounting Policies On January 22, 2020, the Company amended its Sublease Agreement with Cardialen, Inc., reducing monthly rent to $1,350 per month. Because Jeffrey Peters is both a member of our Board and the Chief Executive Officer, President, and a Director of Cardialen, this transaction qualifies as a related party transaction. All related party transactions are reviewed and approved by the Audit Committee or the disinterested members of the full Board.

Segment and Geographic Informat

Segment and Geographic Information	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Segment and Geographic Information	(15) Segment and Geographic Information The Company’s management reviews financial results and manages the business on an aggregate basis. Therefore, financial results are reported in a single operating segment: the development, manufacture, and marketing of orthopedic medical products and devices. The Company attributes revenues to geographic areas based on the location of the customer. Approximately 96% and 95% of sales were in the United States for the nine months ended March 31, 2020 and 2019, respectively. Total revenue by major geographic area is as follows (in thousands): Three Months Ended 2020 2019 United States $ 14,251 $ 16,039 Rest of world 526 687 Total revenue $ 14,777 $ 16,726

Business Description, Basis o_2

Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Policies)	3 Months Ended
	Mar. 31, 2020
Accounting Policies [Abstract]
Business Description and Basis of Presentation	Business Description and Basis of Presentation The accompanying condensed consolidated financial statements include the accounts of Xtant Medical Holdings, Inc. (“Xtant”), a Delaware corporation, and its wholly owned subsidiaries, Xtant Medical, Inc. (“Xtant Medical”), a Delaware corporation, Bacterin International, Inc. (“Bacterin”), a Nevada corporation, and X-spine Systems, Inc. (“X-spine”), an Ohio corporation (Xtant, Xtant Medical, Bacterin, and X-spine are jointly referred to herein as the “Company” or sometimes “we”, “our,” or “us”). All intercompany balances and transactions have been eliminated in consolidation. Xtant is a global medical technology company focused on the design, development, and commercialization of a comprehensive portfolio of orthobiologics and spinal implant systems to facilitate spinal fusion in complex spine, deformity, and degenerative procedures. The accompanying condensed consolidated balance sheet as of December 31, 2019, which has been derived from audited financial statements, and the unaudited interim condensed consolidated financial statements have been prepared in accordance with accounting principles generally accepted in the United States of America. They do not include all disclosures required by generally accepted accounting principles for annual consolidated financial statements, but in the opinion of management include all adjustments, consisting only of normal recurring items, necessary for a fair presentation. Interim results are not necessarily indicative of results that may be achieved in the future for the full year ending December 31, 2020. These condensed consolidated financial statements should be read in conjunction with the consolidated financial statements and notes thereto, which are included in Xtant’s Annual Report on Form 10-K for the year ended December 31, 2019. The accounting policies set forth in those annual consolidated financial statements are the same as the accounting policies utilized in the preparation of these condensed consolidated financial statements, except as modified for appropriate interim consolidated financial statement presentation.
Reclassifications	Reclassifications Certain prior year amounts have been reclassified to conform with current year presentation.
Recent Accounting Pronouncements	Recent Accounting Pronouncements In June 2016, the Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) 2016-13, Financial Instruments–Credit Losses: Measurement of Credit Losses on Financial Instruments Although there are several other new accounting pronouncements issued or proposed by the FASB, which the Company has adopted or will adopt, as applicable, the Company does not believe any of these accounting pronouncements has had or will have a material impact on the Company’s consolidated financial position or operating results.
Use of Estimates	Use of Estimates The preparation of the consolidated financial statements requires management of the Company to make a number of estimates and assumptions relating to the reported amount of assets and liabilities and the disclosure of contingent assets and liabilities at the date of the consolidated financial statements and the reported amounts of revenue and expenses during the period. Significant estimates include the carrying amount of property and equipment, goodwill and intangible assets and liabilities, valuation allowances for trade receivables, inventory and deferred income tax assets and liabilities, current and long-term right-of-use asset, evaluation of ability to continue as a going concern and estimates for the fair value of long-term debt, stock options and other equity awards upon which the Company determines stock-based compensation expense. Actual results could differ from those estimates.
Long-Lived Assets	Long-Lived Assets The Company reviews its long-lived assets for impairment whenever events or changes in circumstances indicate that the carrying amount of the asset may not be recovered. The Company looks primarily to estimated undiscounted future cash flows in its assessment of whether or not long-lived assets are recoverable. As a result of the revenue decline related to the current global novel strain of coronavirus, or COVID-19 pandemic, the Company evaluated whether the carrying values of the long-lived assets were recoverable. Based on these evaluations, the Company determined that the long-lived assets were still recoverable. No impairments of long-lived assets were recorded for the three months ended March 31, 2020 and 2019.
Goodwill	Goodwill Goodwill represents the excess of costs over fair value of assets of businesses acquired. Goodwill and intangible assets acquired in a purchase business combination and determined to have indefinite useful lives are not amortized. Instead, they are tested for impairment at least annually, and whenever events or circumstances indicate, the carrying amount of the asset may not be recoverable. As a result of the current COVID-19 pandemic and its impact on the Company’s projected cash flows, the Company tested goodwill for impairment at the end of the first quarter of 2020. No impairments of goodwill were recorded for the three months ended March 31, 2020 and 2019.
Net Loss Per Share	Net Loss Per Share Basic net income (loss) per share is computed by dividing net income (loss) by the weighted average number of shares of common stock outstanding. Shares issued during the period and shares reacquired during the period are weighted for the portion of the period that they were outstanding. Diluted net income (loss) per share is computed in a manner consistent with that of basic earnings per share while giving effect to all potentially dilutive shares of common stock outstanding during the period, which include the assumed exercise of stock options and warrants using the treasury stock method. Diluted net loss per share was the same as basic net loss per share for the three months ended March 31, 2020 and 2019, as shares issuable upon the exercise of stock options and warrants were anti-dilutive as a result of the net losses incurred for those periods. Dilutive earnings per share are not reported, as the effects of including 4,363,089 and 1,912,567 outstanding stock options, restricted stock units and warrants for the three months ended March 31, 2020 and 2019, respectively, are anti-dilutive.
Fair Value of Financial Instruments	Fair Value of Financial Instruments As of March 31, 2020 and December 31, 2019, the fair value of the Company’s warrant derivative liability was not material. The valuation technique used to measure fair value of the warrant liability is based on a lattice valuation model and significant assumptions and inputs determined by us. The carrying values of financial instruments, including trade accounts receivable, accounts payable, accrued liabilities, and long-term debt, approximate their fair values based on terms and related interest rates as of March 31, 2020 and December 31, 2019.

Revenue (Tables)

Revenue (Tables)	3 Months Ended
	Mar. 31, 2020
Revenue from Contract with Customer [Abstract]
Summary of Revenues from Product Lines	The following table presents revenues from these product lines for the three months ended March 31, 2020 and 2019 (in thousands): Three Months Percentage of Three Months Percentage of March 31, 2020 Total Revenue March 31, 2019 Total Revenue Orthobiologics $ 10,755 73 % $ 12,058 72 % Spinal implant 3,980 27 % 4,628 28 % Other revenue 43 0 % 40 0 % Total revenue $ 14,778 100 % $ 16,726 100 %

Receivables (Tables)

Receivables (Tables)	3 Months Ended
	Mar. 31, 2020
Credit Loss [Abstract]
Schedule of Allowance for Credit Losses	Activity within the allowance for credit losses was as follows for the three months ended March 31, 2020 (in thousands): Balance at January 1, 2020 $ 547 Provision for expected credit losses 138 Write-offs charged against allowance (17 ) Balance at March 31, 2020 $ 668

Inventories (Tables)

Inventories (Tables)	3 Months Ended
	Mar. 31, 2020
Inventory Disclosure [Abstract]
Schedule of Inventories	Inventories consist of the following (in thousands): March 31, 2020 December 31, 2019 Raw materials $ 4,022 $ 3,805 Work in process 2,853 1,603 Finished goods 22,423 22,135 Gross inventories 29,298 27,543 Reserve for obsolescence (11,254 ) (11,442 ) Total $ 18,044 $ 16,101

Property and Equipment, Net (Ta

Property and Equipment, Net (Tables)	3 Months Ended
	Mar. 31, 2020
Property, Plant and Equipment [Abstract]
Schedule of Property and Equipment, Net	Property and equipment, net are as follows (in thousands): March 31, 2020 December 31, 2019 Equipment $ 4,361 $ 4,250 Computer equipment 476 455 Computer software 570 570 Furniture and fixtures 133 124 Leasehold improvements 3,980 3,980 Vehicles 10 10 Surgical instruments 10,960 10,897 Total cost 20,490 20,286 Less: accumulated depreciation (16,187 ) (15,591 ) Property and equipment, net $ 4,303 $ 4,695

Intangible Assets (Tables)

Intangible Assets (Tables)	3 Months Ended
	Mar. 31, 2020
Goodwill and Intangible Assets Disclosure [Abstract]
Schedule of Intangible Assets	The following table sets forth information regarding intangible assets (in thousands): March 31, 2020 December 31, 2019 Patents $ 847 $ 847 Accumulated amortization (347 ) (332 ) Intangible assets, net $ 500 $ 515
Schedule of Estimated Future Amortization Expense for Intangible Assets	The following is a summary of estimated future amortization expense for intangible assets as of March 31, 2020 (in thousands): Remainder of 2020 $ 42 2021 55 2022 54 2023 53 2024 52 Thereafter 244 Total $ 500

Accrued Liabilities (Tables)

Accrued Liabilities (Tables)	3 Months Ended
	Mar. 31, 2020
Payables and Accruals [Abstract]
Schedule of Accrued Liabilities	Accrued liabilities consist of the following (in thousands): March 31, 2020 December 31, 2019 Wages/commissions payable $ 2,313 $ 3,902 Other accrued liabilities 3,597 2,723 Accrued liabilities $ 5,910 $ 6,625

Debt (Tables)

Debt (Tables)	3 Months Ended
	Mar. 31, 2020
Debt Disclosure [Abstract]
Schedule of Long-term Debt	Long-term debt consists of the following (in thousands): March 31, 2020 December 31, 2019 Amounts due under the Second Amended and Restated Credit Agreement $ 72,657 $ 72,657 PIK interest payable related to Second Amended and Restated Credit Agreement 4,229 3,280 Plus: 2% exit fee on prior credit agreement 533 399 Gross long-term debt 77,419 76,336 Less: total debt issuance costs on Credit Agreements (74 ) (92 ) Long-term debt, less issuance costs $ 77,345 $ 76,244

Stock-Based Compensation (Table

Stock-Based Compensation (Tables)	3 Months Ended
	Mar. 31, 2020
Share-based Payment Arrangement [Abstract]
Schedule of Share-based Compensation, Stock Options, Activity	Stock option activity, including options granted under the Xtant Medical Holdings, Inc. 2018 Equity Incentive Plan, as amended (the “2018 Plan”), and the Amended and Restated Xtant Medical Equity Incentive Plan and options granted to new hires to purchase shares of our common stock outside of any stockholder-approved plan , was as follows: 2020 2019 Shares Weighted Weighted Shares Weighted Weighted Outstanding at January 1 602,966 $ 6.07 $ 3.99 496,958 $ 9.90 $ 6.62 Granted - $ - $ - 100,000 $ 2.24 $ 1.95 Cancelled or expired (76,299 ) $ 4.18 $ 2.96 (395,000 ) $ 4.71 $ 3.69 Outstanding at March 31 526,667 $ 6.34 $ 4.14 201,958 $ 10.62 $ 6.74 Exercisable at March 31 48,764 $ 41.11 $ 23.34 71,249 $ 24.35 $ 14.09

Commitments and Contingencies (

Commitments and Contingencies (Tables)	3 Months Ended
	Mar. 31, 2020
Commitments and Contingencies Disclosure [Abstract]
Schedule of Right-of-use Assets and Lease Liability	Present Value of Long-term Leases (in thousands): March 31, 2020 Right-of-use assets, net $ 1,999 Current portion of lease liability 401 Lease liability, less current portion 1,623 Total lease liability $ 2,024
Schedule of Future Minimum Rental Payments for Operating Leases	Future minimum payments for the next five years and thereafter as of March 31, 2020 under these long-term operating leases are as follows (in thousands): Remainder of 2020 $ 376 2021 507 2022 521 2023 489 2024 224 Thereafter 179 Total future minimum lease payments 2,296 Less amount representing interest (272 ) Present value of obligations under operating leases 2,024 Less current portion (401 ) Long-term operating lease obligations $ 1,623
Schedule of Future Minimum Lease Payments for Financing Leases	Future minimum payments under finance leases are as follows as of March 31, 2020 (in thousands): Remainder of 2020 $ 144 Less amount representing interest (6 ) Present value of obligations under financing leases $ 138

Supplemental Disclosure of Ca_2

Supplemental Disclosure of Cash Flow Information (Tables)	3 Months Ended
	Mar. 31, 2020
Supplemental Cash Flow Elements [Abstract]
Schedule of Supplemental Cash Flow Information	Supplemental cash flow information is as follows (in thousands): Three Months Ended March 31, 2020 2019 Supplemental disclosure of cash flow information Cash paid during the period for: Interest $ 7 $ 27 Non-cash activities: ASU 2016-13 cumulative effect adjustment $ 47 $ — Lease liability from right-of-use assets $ — $ 2,658 Extinguishment of Prior Credit Agreement (including debt issuance costs) $ — $ 307 Recognition of Second Amended and Restated Credit Agreement $ — $ 72,657 Recognition of 2019 Warrants $ — $ 9

Segment and Geographic Inform_2

Segment and Geographic Information (Tables)	3 Months Ended
	Mar. 31, 2020
Segment Reporting [Abstract]
Schedule of Revenues by Geographic Region	The Company attributes revenues to geographic areas based on the location of the customer. Approximately 96% and 95% of sales were in the United States for the nine months ended March 31, 2020 and 2019, respectively. Total revenue by major geographic area is as follows (in thousands): Three Months Ended 2020 2019 United States $ 14,251 $ 16,039 Rest of world 526 687 Total revenue $ 14,777 $ 16,726

Business Description, Basis o_3

Business Description, Basis of Presentation and Summary of Significant Accounting Policies (Details Narrative) - USD ($) $ in Thousands	Jan. 02, 2020	Mar. 31, 2020	Mar. 31, 2019
Cumulative effect adjustment		$ (47)
Impairment of long lived assets
Impairment of goodwill
Antidilutive securities excluded from computation of earnings per share, amount		4,363,089	1,912,567
Accounting Standards Update 2016-13 [Member]
Cumulative effect adjustment	$ 47

Revenue - Summary of Revenues f

Revenue - Summary of Revenues from Product Lines (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Total revenue	$ 14,778	$ 16,726
Percentage of total revenue	100.00%	100.00%
Orthobiologics [Member]
Total revenue	$ 10,755	$ 12,058
Percentage of total revenue	73.00%	72.00%
Spinal Implant [Member]
Total revenue	$ 3,980	$ 4,628
Percentage of total revenue	27.00%	28.00%
Other Revenue [Member]
Total revenue	$ 43	$ 40
Percentage of total revenue	0.00%	0.00%

Receivables -Schedule of allowa

Receivables -Schedule of allowance for credit losses (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Credit Loss [Abstract]
Beginning balance	$ 547
Provision for expected credit losses	138	$ 94
Write-offs charged against allowance	(17)
Ending balance	$ 668

Inventories - Schedule of Inven

Inventories - Schedule of Inventories (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Inventory Disclosure [Abstract]
Raw materials	$ 4,022	$ 3,805
Work in process	2,853	1,603
Finished goods	22,423	22,135
Gross inventories	29,298	27,543
Reserve for obsolescence	(11,254)	(11,442)
Total	$ 18,044	$ 16,101

Property and Equipment, Net (De

Property and Equipment, Net (Details Narrative) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019	Dec. 31, 2019
Depreciation expense	$ 700	$ 800
Gross assets	20,490		$ 20,286
Accumulated depreciation	16,187		$ 15,591
Finance Leases Equipment [Member]
Gross assets	1,400
Accumulated depreciation	$ 1,000

Property and Equipment, Net - S

Property and Equipment, Net - Schedule of Property and Equipment, Net (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Property, Plant and Equipment [Line Items]
Total cost	$ 20,490	$ 20,286
Less: accumulated depreciation	(16,187)	(15,591)
Property and equipment, net	4,303	4,695
Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	4,361	4,250
Computer Equipment [Member]
Property, Plant and Equipment [Line Items]
Total cost	476	455
Computer Software [Member]
Property, Plant and Equipment [Line Items]
Total cost	570	570
Furniture and Fixtures [Member]
Property, Plant and Equipment [Line Items]
Total cost	133	124
Leasehold Improvements [Member]
Property, Plant and Equipment [Line Items]
Total cost	3,980	3,980
Vehicles [Member]
Property, Plant and Equipment [Line Items]
Total cost	10	10
Surgical Instruments [Member]
Property, Plant and Equipment [Line Items]
Total cost	$ 10,960	$ 10,897

Intangible Assets - Schedule of

Intangible Assets - Schedule of Intangible Assets (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Goodwill and Intangible Assets Disclosure [Abstract]
Patents	$ 847	$ 847
Accumulated amortization	(347)	(332)
Intangible assets, net	$ 500	$ 515

Intangible Assets - Schedule _2

Intangible Assets - Schedule of Estimated Future Amortization Expense for Intangible Assets (Details) $ in Thousands	Mar. 31, 2020USD ($)
Goodwill and Intangible Assets Disclosure [Abstract]
Remainder of 2020	$ 42
2021	55
2022	54
2023	53
2024	52
Thereafter	244
Total	$ 500

Accrued Liabilities - Schedule

Accrued Liabilities - Schedule of Accrued Liabilities (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Payables and Accruals [Abstract]
Wages/commissions payable	$ 2,313	$ 3,902
Other accrued liabilities	3,597	2,723
Accrued liabilities	$ 5,910	$ 6,625

Debt (Details Narrative)

Debt (Details Narrative) - USD ($) $ / shares in Units, $ in Thousands	May 06, 2020	Mar. 31, 2020	Dec. 31, 2019
Issuance of warrants to purchase a common stock		2,908,874	2,908,874
Exercise price of warrants		$ 4.16	$ 4.16
Sole Holders [Member]
Beneficially owned percentage		75.00%
Lenders [Member]
Beneficially owned percentage		70.00%
Subsequent Event [Member] | 2020 Warrants [Member] | Lenders [Member]
Issuance of warrants to purchase a common stock	2,400,000
Exercise price of warrants	$ 0.01
Warrants expiration date	Jun. 30, 2030
Second Amended and Restated Credit Agreement [Member]
Debt instrument description		Beginning April 1, 2020 through the maturity date of the Second Amended and Restated Credit Agreement, interest payable in cash will accrue on the Loans under the Credit Agreement at a rate per annum equal to the sum of (a) 10.00% plus (b) the higher of (x) the LIBO Rate (as such term is defined in the Second Amended and Restated Credit Agreement) and (y) 2.3125%.
Debt instrument maturity date		Mar. 31, 2021
Second Amended and Restated Credit Agreement [Member] | Subsequent Event [Member]
Debt instrument description	Beginning October 1, 2020 through the maturity date of the Second A&R Credit Agreement, interest payable in cash will accrue on the Loans under the Second A&R Credit Agreement at a rate per annum equal to the sum of (i) 10.00% plus (ii) the higher of (x) the LIBO Rate (as such term is defined in the Second A&R Credit Agreement) and (y) 2.3125%;
Debt instrument maturity date	Dec. 31, 2021
Second Amended and Restated Credit Agreement [Member] | ROS and Lenders [Member]
Draw of loan advances		$ 2,200
Debt aggregate amount		$ 10,000

Debt - Schedule of Long-term De

Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Debt Disclosure [Abstract]
Amounts due under the Second Amended and Restated Credit Agreement	$ 72,657	$ 72,657
PIK interest payable related to Second Amended and Restated Credit Agreement	4,229	3,280
Plus: 2% exit fee on prior credit agreement	533	399
Gross long-term debt	77,419	76,336
Less: total debt issuance costs on Credit Agreements	(74)	(92)
Long-term debt, less issuance costs	$ 77,345	$ 76,244

Stock-Based Compensation (Detai

Stock-Based Compensation (Details Narrative) - 2018 Equity Incentive Plan [Member]	3 Months Ended
	Mar. 31, 2020shares
Restricted stock granted during period, shares	489,437
Restricted stock granted vested weighted average period	1 year 6 months

Stock-Based Compensation - Sche

Stock-Based Compensation - Schedule of Share-based Compensation, Stock Options, Activity (Details) - Equity Option [Member] - $ / shares	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Shares Outstanding, Beginning Balance	602,966	496,958
Shares Granted		100,000
Shares Cancelled or expired	(76,299)	(395,000)
Shares Outstanding, Ending Balance	526,667	201,958
Shares Exercisable, Ending Balance	48,764	71,249
Weighted Average Exercise Price, Outstanding Beginning Balance	$ 6.07	$ 9.90
Weighted Average Exercise Price, Granted		2.24
Weighted Average Exercise Price, Cancelled or expired	4.18	4.71
Weighted Average Exercise Price, Outstanding Ending Balance	6.34	10.62
Weighted Average Exercise Price, Exercisable Ending Balance	41.11	24.35
Weighted Average Fair Value at Grant Date, Outstanding Beginning Balance	3.99	6.62
Weighted Average Fair Value at Grant Date, Granted		1.95
Weighted Average Fair Value at Grant Date, Cancelled or expired	2.96	3.69
Weighted Average Fair Value at Grant Date, Outstanding Ending Balance	4.14	6.74
Weighted Average Fair Value at Grant Date, Exercisable, Ending Balance	$ 23.34	$ 14.09

Warrants (Details Narrative)

Warrants (Details Narrative) - $ / shares	Mar. 31, 2020	Dec. 31, 2019
Class of Warrant or Right [Line Items]
Issuance of warrants to purchase a common stock	2,908,874	2,908,874
Exercise price of warrants	$ 4.16	$ 4.16
Derivative Liability [Member]
Class of Warrant or Right [Line Items]
Issuance of warrants to purchase a common stock	87,509

Commitments and Contingencies_2

Commitments and Contingencies (Details Narrative) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Operating lease expiration description	Expiration dates between 2023 and 2025
Operating lease weighted-average remaining lease term	4 years 7 months 6 days
Operating lease weighted-average discount rate	5.20%
Rent expense	$ 100	$ 100

Commitments and Contingencies -

Commitments and Contingencies - Schedule of Right-of-use Assets and Lease Liability (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Right-of-use assets, net	$ 1,999	$ 2,100
Current portion of lease liability	401	394
Lease liability, less current portion	1,623	$ 1,726
Total lease liability	$ 2,024

Commitments and Contingencies_3

Commitments and Contingencies - Schedule of Future Minimum Rental Payments for Operating Leases (Details) - USD ($) $ in Thousands	Mar. 31, 2020	Dec. 31, 2019
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2020	$ 376
2021	507
2022	521
2023	489
2024	224
Thereafter	179
Total future minimum lease payments	2,296
Less amount representing interest	(272)
Present value of obligations under operating leases	2,024
Less current portion	(401)	$ (394)
Long-term operating lease obligations	$ 1,623	$ 1,726

Commitments and Contingencies_4

Commitments and Contingencies - Schedule of Future Minimum Lease Payments for Financing Leases (Details) $ in Thousands	Mar. 31, 2020USD ($)
Commitments and Contingencies Disclosure [Abstract]
Remainder of 2020	$ 144
Less amount representing interest	(6)
Present value of obligations under financing leases	$ 138

Income Taxes (Details Narrative

Income Taxes (Details Narrative) - USD ($)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Income Tax Disclosure [Abstract]
Interest or penalties related to income taxes

Supplemental Disclosure of Ca_3

Supplemental Disclosure of Cash Flow Information - Schedule of Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Supplemental Cash Flow Elements [Abstract]
Interest	$ 7	$ 27
ASU 2016-13 cumulative effect adjustment	47
Lease liability from right of use asset		2,658
Extinguishment of Prior Credit Agreement (including debt issuance costs)		307
Recognition of Second Amended and Restated Credit Agreement		72,657
Recognition of 2019 Warrants		$ 9

Related Party Transactions (Det

Related Party Transactions (Details Narrative) - USD ($) $ in Thousands	Jan. 22, 2020	Mar. 31, 2020	Mar. 31, 2019
Related Party Transaction [Line Items]
Rent expense		$ 100	$ 100
ROS [Member]
Related Party Transaction [Line Items]
Ownership percentage		70.00%
Cardialen, Inc., [Member] | Sublease Agreement [Member]
Related Party Transaction [Line Items]
Rent expense	$ 1,350

Segment and Geographic Inform_3

Segment and Geographic Information (Details Narrative)	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
United States [Member] | Revenue [Member] | Geographic Concentration Risk [Member]
Concentration risk, percentage	96.00%	95.00%

Segment and Geographic Inform_4

Segment and Geographic Information - Schedule of Revenues by Geographic Region (Details) - USD ($) $ in Thousands	3 Months Ended
	Mar. 31, 2020	Mar. 31, 2019
Total revenue	$ 14,777	$ 16,726
United States [Member]
Total revenue	14,251	16,039
Rest of World [Member]
Total revenue	$ 526	$ 687