Neurotech.
China billed first.

Thirteen.

That's how many brain-computer interfaces Neuracle had sold by the time it updated its Shanghai IPO filing in late September. It's a tiny number, and it's also the first time anyone, anywhere, has sold an implanted brain-computer interface as a regular medical product.

It happened in China because China built the payment system first. The national health insurance agency set pricing rules for brain-computer interface procedures before the device was even approved in March, and 27 provinces have since listed it for hospital purchasing. In the U.S., no implanted brain-computer interface has full FDA approval, and Medicare has no payment code for one.

Brain-computer interfaces, or BCIs, are the part of neurotech that makes headlines: implants that read brain signals so a paralyzed person can move a cursor just by thinking. Neurotech as a whole covers any device that reads from or stimulates the nervous system, and its other half is a mature business, with implants that send electrical pulses to the brain, spine, or vagus nerve to treat Parkinson's, chronic pain, epilepsy, and depression.

Private investors are pouring money into the BCI half. Precision Neuroscience, Science Corp, and Sam Altman's Merge Labs have raised more than $700 million between them this year, and Neuralink shares have reportedly changed hands at valuations up to $42 billion. The public neurotech stocks have had a much rougher year, and the ones that fell hardest got hurt by payment, not science.

That's the lesson running through this whole list. In neurotech, the reimbursement code is the product, and these neurotech stocks are grouped by how well each company has solved getting paid: the ones already collecting, the ones the fine print hurt, the tool everyone needs, the interface that skips surgery, China's first mover, and the private BCI companies still waiting for their turn.

These companies sell neurostimulation devices that insurers already cover. That's the boring corner of neurotech stocks, and it's where the cash is.

Medtronic NYSE: MDT

Medtronic has been putting deep brain stimulators into Parkinson's patients for decades, and in 2025 it won FDA approval for the first adaptive version, one that listens to the brain and adjusts its own stimulation. Its neuroscience business did $2.7 billion of revenue last quarter, up 9% organically.

It's here because every brain implant company eventually needs what Medtronic already has: neurosurgeons who trust its equipment, hospital contracts and a sales force. In January it signed on to integrate Precision Neuroscience's thin-film brain sensor with its surgical navigation system. When BCI is ready for scale, Medtronic is the obvious partner or buyer.

LivaNova NASDAQ: LIVN

LivaNova makes vagus nerve stimulators, implants in the neck that have treated epilepsy for decades. That business grew about 10% last quarter, and management raised guidance.

The bigger news came in March, when the FDA approved its device for obstructive sleep apnea. That's a huge market with a reimbursement path already carved out by others, and LivaNova enters it just as the incumbent stumbled over billing.

BrainsWay NASDAQ: BWAY

BrainsWay makes transcranial magnetic stimulation systems: a helmet that sends magnetic pulses into the brain to treat depression and OCD, with no surgery. Insurers already pay for it.

Revenue grew 35% last quarter on a record 125 systems shipped, and it raised guidance. In a field obsessed with drilling into skulls, the fastest grower on this list doesn't drill at all.

Approval and payment can still be taken away, or never arrive.

NeuroPace NASDAQ: NPCE

NeuroPace sells the RNS system, an implant that watches for the start of a seizure and stops it with a burst of stimulation. It's approved, it's paid for, and that core business grew 21% last quarter.

The growth plan was a second type of epilepsy. In July, the FDA said that application was "not approvable in its current form" and asked for more evidence, even though the trial showed a 77% median reduction in the most dangerous seizures. NeuroPace is going back to the agency. Until it gets through, this is a good business stuck at its current size.

Inspire Medical Systems NYSE: INSP

Inspire Medical Systems makes a nerve stimulator for sleep apnea, and it's the cautionary tale for this whole list. Its device didn't stop working. Billing changed. Revenue fell almost 8% last quarter, and the company blamed shifts in coding and reimbursement.

It's still a business with about $850 million in expected revenue this year, and the stock is down about a quarter. That's a turnaround, and it's here because it shows exactly what every BCI company will face once it's approved: the hard part comes after the FDA says yes.

ClearPoint Neuro NASDAQ: CLPT

ClearPoint Neuro makes navigation systems that let a surgeon guide a needle, electrode or catheter into an exact spot in the brain using live MRI. It doesn't care whose implant or gene therapy goes in.

That makes it the picks-and-shovels play on getting things into the brain. Revenue grew 18% last quarter. Its drug-delivery partners say cell and gene therapies delivered with its system could be approved by the end of 2027. The stock is down about 20% this year, which is the price of being early.

Meta NASDAQ: META

Meta sells the only neural interface you can buy in a store. Its Neural Band, which ships with the Meta Ray-Ban Display glasses, reads the electrical signals from your wrist muscles so you can control the glasses with tiny finger movements.

It's not a brain implant, and it's a rounding error inside Meta. But demand was strong enough that Meta paused its international rollout in January to catch up on supply. If neural interfaces go mainstream, the first one most people use will probably be on their wrist, and Meta got there first.

Neuracle (SSE STAR, in review)

Neuracle makes NEO, a coin-sized implant placed under the skull but outside the brain's protective membrane that lets people with spinal cord injuries control hand movement. China approved it in March, and it made its first commercial sale in July.

Its Shanghai STAR Market IPO application was accepted in June and is now in review, with a planned raise of RMB 2.5 billion. It isn't listed yet, and U.S. investors will find it hard to buy when it is. It's on this list because whatever Neuracle trades at becomes the first public price for a commercial BCI company, and every private valuation in the West will be measured against it.

The rest of the brain-computer interface field is private, well funded, and still waiting for permission to sell.

Neuralink (Private)

Neuralink has implanted more patients than any other U.S. BCI company, 21 as of January. Its last formal round valued it around $9 billion. Private secondary trades this summer reportedly priced it at $29 billion to $42 billion.

It's working on implants for speech and for restoring some sight, both with FDA breakthrough designations. For now, it's a well-funded clinical trial with a famous owner.

Synchron (Private)

Synchron doesn't open the skull. Its Stentrode goes up through a blood vessel and sits against the brain from inside a vein. Last year it became the first BCI to plug natively into Apple devices, through a protocol Apple built for brain interfaces.

It raised $200 million last November. It hasn't announced the start of its pivotal trial, the one that would lead to approval.

Precision Neuroscience (Private)

Precision Neuroscience makes a sensor film thinner than a human hair that rests on the brain's surface. In 2025 it won FDA clearance for that sensor, though only for use of up to 30 days, mostly for mapping the brain during surgery.

That's a real foothold. It's in hospitals, it's working with Medtronic, and it has done more than 100 procedures. In September it raised $250 million in a round led by Bill Ackman's Pershing Square.

Science Corp (Private)

Science Corp was started by Neuralink's former president, and it beat everyone in the West to a commercial neural implant. Its PRIMA retinal implant, which restores some sight to people blinded by advanced macular degeneration, won European approval and launched commercially there in July.

It raised $230 million in March. Science is the first of the new wave of neural implant companies with a product on sale in a major Western market, and that makes it a natural candidate to be the first of them to go public.

The next big advantage in brain-computer interfaces is data, and China is about to have more of it.

A BCI is only as good as the software that turns brain signals into intentions. That software learns from patients. Neuralink's newest research is about pretraining its decoders across many people, the way language models learn from many texts. The more patients you have, the better your next patient's implant works on day one.

The U.S. leaders have a few dozen long-term implant patients between them, all in trials. Neuracle is selling into 27 provinces with a price and a reimbursement path, and other Chinese BCI makers are lining up behind it. Even at a modest pace, Chinese companies could have more implanted patients than the entire U.S. field within a year or two.

That's the real cost, for American neurotech stocks, of letting China approve and pay first. American companies may still have the better hardware. But if decoding is where the value ends up, the winner could be whoever got the most brains talking to it earliest.