Castle Biosciences shows a perfect recent earnings-beat streak and steep analyst-implied upside, with technicals reading as a pullback rather than a breakdown, but a sub-floor quality score, a failing Rule of 40 metric, and notable insider selling keep the engine's stance at exit.
Thesis pillars
- Analyst Upside Valuation↓Deteriorating
- Earnings Beat Streak↓Deteriorating
- Momentum Pullback Not Breakdown↑Improving
- +2 more pillars — see the Why tab for full reasoning
Pillars as of Jul 5, 2026, based on the 10-K filed Feb 26, 2026
Castle Biosciences, Inc. (CSTL) Stock Analysis
Breakout setup
Healthcare · Diagnostics & Research
Sell if holding. Engine safety override at $36.68: Quality below floor (3.6 < 4.0) triggers a hard block regardless of the otherwise-positive setup — overall score 5.9/10. Specifically: Below-average business quality.
Castle Biosciences is a molecular diagnostics company selling gene-expression profile and spatialomics tests — including DecisionDx-Melanoma, TissueCypher, DecisionDx-SCC, MyPath Melanoma, and DecisionDx-UM — that guide treatment decisions in dermatologic cancers, Barrett's... Read more
Sell if holding. Engine safety override at $36.68: Quality below floor (3.6 < 4.0) triggers a hard block regardless of the otherwise-positive setup — overall score 5.9/10. Specifically: Below-average business quality. Chart setup: Golden cross, above all MAs, RSI 62, MACD bullish. Score 5.9/10, moderate confidence.
Passes 5/8 gates (positive momentum, no SEC red flags, news events none recent, semi cycle peak clear, materials cycle peak clear). Fails on favorable risk/reward ratio and clean insider activity and earnings proximity 7d<=7d. Suitability: aggressive.
About Castle Biosciences, Inc.
About Castle Biosciences, Inc.
Castle Biosciences delivered 105,053 diagnostic test reports across its dermatology, gastroenterology, and ophthalmology portfolio in 2025, up from 96,071 in 2024, driving net revenues of $344.2 million for the year ended December 31, 2025 versus $332.1 million in 2024. The molecular diagnostics company runs its DecisionDx-Melanoma, TissueCypher, DecisionDx-SCC, MyPath Melanoma, and DecisionDx-UM tests from labs in Phoenix, Arizona and Pittsburgh, Pennsylvania.
Castle Biosciences earns revenue by billing government and commercial third-party payors for each test report, with reimbursement rates set under Medicare's Advanced Diagnostic Laboratory Test framework — $7,193 per DecisionDx-Melanoma test, $4,950 per TissueCypher test, and $7,776 per DecisionDx-UM test for 2026. TissueCypher led 2025 volume growth at 39,014 reports, up from 20,956 in 2024, while the company discontinued its IDgenetix pharmacogenomic test in May 2025 and began a limited launch of the AdvanceAD-Tx atopic-dermatitis test that November. The company expanded its Barrett's esophagus franchise in 2025 through the acquisition of Previse, adding methylation-based intellectual property and a non-endoscopic cell-collection device expected to support a supplemental Esopredict test in 2026, and separately licensed SciBase's Electrical Impedance Spectroscopy technology for North American dermatology diagnostics.
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Medicare supplied 44% of Castle Biosciences' revenue in 2025 and a single unnamed commercial payor contributed another 16%, concentrating close to two-thirds of revenue in two payor relationships. That dependence is sharpened by DecisionDx-SCC's Medicare coverage loss: Medicare contractor Novitas finalized a non-coverage local coverage determination effective April 24, 2025 after a multi-year review process, and while Castle submitted reconsideration requests to both Novitas and the Palmetto MolDX program in July 2025, confirmation that a request is valid does not indicate a favorable outcome is coming.
See also: Healthcare · Diagnostics & Research
From Castle Biosciences, Inc.'s most recent 10-K filing, extracted July 6, 2026.
Recent developments
updated 2026-10-29Recent Developments — Castle Biosciences, Inc.
Latest news
- NEWS Castle Biosciences to Present at the Stephens Annual Investment Conference — fiscal.ai Oct 28, 2026
- NEWS Castle Biosciences To Present New Data From Three Studies Evaluating Its TissueCypher Barrett's Esophagus Test At ACG 20 — benzinga Oct 12, 2026 positive
- NEWS Castle Biosciences To Present New Data On DecisionDx-Melanoma At EADV Congress 2026 — benzinga Sep 30, 2026 positive
- NEWS Castle Biosciences Announces Publication Of New Study Highlighting Demand For Molecular Testing In Atopic Dermatitis — benzinga Sep 24, 2026 positive
- NEWS Castle Biosciences Announces Opening Of New Laboratory And Office Facility In Scottsdale, Arizona — benzinga Sep 22, 2026 positive
Generated 2026-10-29T11:48:39Z.
Upcoming dated catalysts
Thesis
Key Metrics
Quality Signals
Options Flow
Concentration Risks(10-K Item 1A)
- MEDIUMCustomerMedicare44%10-K Item 1: 'Our revenue from patients covered by Medicare as a percentage of total revenue, was 44% for the year ended December 31, 2025.'
- LOWCustomersingle commercial payor16%10-K Item 1: 'there was a commercial payor from which 16% of our revenue from patients was derived for the year ended December 31, 2025.'
Model-generated analysis — not investment advice. Not a registered investment advisor. Past performance does not guarantee future results. How we score · Editorial policy
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Rating Breakdown
2 floor-breakers
Technicals below the gate floor. Component breakdown shows what dragged the score down.static
Unprofitable operations — net margin -5.4%. Quality floor flags this regardless of sector context.static
Price Targets
Position Sizing
Risk Alerts
Earnings
Verdict History
Frequently Asked Questions
Sell if holding. Engine safety override at $36.68: Quality below floor (3.6 < 4.0) triggers a hard block regardless of the otherwise-positive setup — overall score 5.9/10. Specifically: Below-average business quality. Chart setup: Golden cross, above all MAs, RSI 62, MACD bullish. Prior stop was $34.11. Score 5.9/10, moderate confidence.
Analyst target: $39.34 (+7.3% upside). Prior stop was $34.11. Stop-loss: $34.11.
Quality below floor (3.6 < 4.0).
Castle Biosciences, Inc. trades at a P/E of N/A (forward -40.2). TrendMatrix value score: 6.9/10. Verdict: Sell.
15 analysts cover CSTL with a consensus score of 4.4/5. Average price target: $45.
What does Castle Biosciences, Inc. do?Castle Biosciences is a molecular diagnostics company selling gene-expression profile and spatialomics tests —...
Castle Biosciences is a molecular diagnostics company selling gene-expression profile and spatialomics tests — including DecisionDx-Melanoma, TissueCypher, DecisionDx-SCC, MyPath Melanoma, and DecisionDx-UM — that guide treatment decisions in dermatologic cancers, Barrett's esophagus, and atopic dermatitis. The company delivered 105,053 test reports and generated $344.2 million in net revenue in 2025, with Medicare accounting for 44% of revenue and a single commercial payor contributing 16%.