Intuitive Surgical Stock Falls as $450 Million Settlement and Tighter Outlook Overshadow Earnings Beat

Updated 09:13 UTC, October 21, 2026. Developing story.

Intuitive Surgical reported third quarter results after the close on Tuesday that beat Wall Street estimates on both revenue and adjusted profit, and investors sold the stock anyway.

Shares of the Sunnyvale, California company fell about 7 percent in extended trading, after ending the regular session up 1.1 percent at $438. The drop followed two pieces of news buried in an otherwise strong report: a $450 million pretax charge to settle antitrust litigation, and a narrower forecast for procedure growth in 2026.

Revenue rose 22 percent from a year earlier to $3.05 billion, ahead of the $2.91 billion analysts expected, according to data compiled by LSEG. Adjusted earnings came in at $3 a share, up 25 percent and well ahead of estimates near $2.65 a share.

Reported profit told a different story. Net income under standard accounting rules fell to $523 million, or $1.49 a share, from $704 million, or $1.95 a share, in the same quarter of 2025. The settlement charge accounts for the gap. Intuitive said the $450 million pretax charge, $347 million after tax or 99 cents a share, covers a proposed settlement of antitrust class action litigation tied to the servicing and repair of instruments used with its da Vinci systems. The cases date back to 2021. The company did not admit wrongdoing, and the settlement still needs court approval.

The forecast investors focused on

Intuitive narrowed its outlook for worldwide da Vinci procedure growth in 2026 to between 14 percent and 15 percent, with growth now expected near the midpoint of that range. Its previous forecast ran from 13.5 percent to 15.5 percent, so the midpoint held while the top end came down.

Procedure growth is the number this stock trades on. Every operation performed with a da Vinci system uses instruments and accessories that hospitals must buy again, so procedure volume drives the recurring revenue at the center of the business. Instruments and accessories revenue rose 18 percent in the quarter to $1.8 billion.

Worldwide procedures grew about 15 percent in the third quarter. Da Vinci procedures rose 14 percent and Ion procedures, the company's lung biopsy platform, rose 31 percent. Growth was uneven by region: da Vinci procedures rose 10 percent in the United States and 20 percent outside it. The company also placed 546 da Vinci systems in the quarter, up 28 percent from a year earlier.

Policy headwinds in the United States

Finance chief Jamie Samath said the company continues to watch lower Affordable Care Act enrollment, changes to Medicaid eligibility and possible changes to the 340B drug pricing program, all of which can affect how many patients in the United States can pay for surgery. Intuitive said in July that the expiration of enhanced Affordable Care Act subsidies had already had a modest adverse effect on procedure growth in the United States.

The company also plans to roll out an Extended Use Program, designed to lower instrument costs and widen access to robotic surgery, with the United States as its first market once regulatory clearance is in place.

The quarter leaves investors weighing a business that is still growing fast against a stock that had run up more than 27 percent from its September low before Tuesday, a legal bill that still needs a judge's sign off, and a United States market where procedure growth has slowed to 10 percent.