Insurance Coding for Peptide Therapy in Concierge Clinics

 

Four-panel cartoon showing a doctor explaining peptide therapy insurance coding. Panel 1: Doctor says it's like teaching a cat to swim. Panel 2: Peptide not FDA approved, insurance usually doesn't cover. Panel 3: Clinics use cash-pay models. Panel 4: Billing tips—stick to cash-pay, document thoroughly, make no false promises.

Insurance Coding for Peptide Therapy in Concierge Clinics

Peptide therapy is no longer fringe biohacking—it’s edging into the mainstream of regenerative and concierge medicine.

But as more patients ask for BPC-157 or thymosin alpha-1 alongside their vitamin drips, physicians are asking a harder question:

“How the heck do I code this?”

Navigating insurance for peptides is like trying to explain crypto to your grandfather—technically possible, but it rarely ends well.

In this post, we’ll explore the evolving rules, common CPT coding strategies, legal pitfalls, and why most clinics are turning to cash-pay models.

πŸ“Œ Table of Contents

What Is Peptide Therapy and Why It’s Booming

Peptides are short chains of amino acids that signal specific physiological functions—improving metabolism, reducing inflammation, repairing tissue, and boosting growth hormone.

Once reserved for elite athletes and body hackers, peptides like CJC-1295, Ipamorelin, and BPC-157 are now offered in clinics from L.A. to Louisville.

But while demand is booming, the legal and billing frameworks haven’t caught up.

Can You Bill Peptides Through Insurance?

Here’s the unfiltered answer: Usually, no.

Most peptide compounds are not FDA-approved for specific therapeutic uses. That means no NDC, no CMS coverage, and no dice with payers.

Some clinics try billing under general wellness categories, but this opens doors to clawbacks.

That said, the reimbursement landscape is evolving. In rare post-surgical or injury contexts, a few payers may allow case-by-case review—if charting is airtight.

One of our partner clinics in Arizona submitted claims for thymosin alpha-1 in immunocompromised patients. They included exhaustive SOAP notes, a physician’s letter, and lab results. Still denied.

Their words: “If it’s not formulary-approved, it’s a cash conversation.”

CPT and HCPCS Codes for Peptide-Related Services

While you can’t bill the peptide itself, these codes are frequently used to bill administration or visits:

  • 96372: SubQ or IM therapeutic injection

  • 99213–99215: Established patient visit (based on time/complexity)

  • A9270: “Non-covered service” placeholder

Note that A9270 is especially helpful when you’re formally documenting that a service is billed to the patient, not insurance.

Why Most Concierge Clinics Go Cash-Only

Insurance won’t touch peptides, so clinics bundle them into wellness memberships or package pricing.

It also gives freedom from insurer red tape. If you’ve ever waited 42 minutes to get a payer rep on the phone, you know what we mean.

One physician told us: “I’d rather talk to 10 patients than file one appeal. That’s why we dropped insurance altogether.”

Case Studies: Billing Gone Wrong

In New Jersey, a clinic advertised “insurance-covered peptides” on their homepage. That alone triggered a board complaint.

They weren’t even billing improperly—just marketing loosely.

Their medical director got a call from the malpractice carrier. Yikes.

Takeaway? Compliance starts before the first visit. Even your landing page matters.

Compliance Risks with Peptide Marketing

The FDA is actively monitoring peptides like BPC-157 and Tesamorelin, especially if advertised for “healing” or “performance.”

503A pharmacies may compound, but cross-state shipping, lack of labeling, or “wellness” claims can trigger warnings.

We strongly recommend avoiding phrases like “covered by most insurances” unless you have documentation.

Best Practices for Documentation

If you’re offering peptides, document:

  • Chief complaint + rationale

  • Lab values, where relevant

  • Physician notes on off-label status

  • Patient signature on non-covered service form

Use language that a payer auditor would understand—not just “patient felt tired,” but “reported chronic fatigue unresponsive to previous interventions.”

Final Thoughts: Billing Smart in 2025

Peptide therapy holds promise, but billing remains the Wild West.

Stick to cash-pay when possible, chart like you’re defending in court, and don’t make coverage promises you can’t keep.

Above all—don’t try to out-code the system. Insurers have bigger algorithms than we do.

πŸ”— Further Reading & Professional Guidance


Keywords: peptide therapy billing, concierge medicine coding, CPT insurance peptides, non-covered therapy charting, FDA peptide risk