Optum & HealthEquity FSA rejected my compounded peptide claim: exact LMN wording that passed
I submitted my receipt for compounded Tirzepatide to HealthEquity for FSA reimbursement, and they denied it claiming it was a 'cosmetic weight loss expense'. What specific Letter of Medical Necessity (LMN) documentation and ICD-10 diagnostic codes do I need to get this approved?
Brandon, this is a standard automated denial by third-party administrators (TPAs) whenever an expense is flagged as 'weight loss'. Under IRS Revenue Ruling 2002-19, general weight reduction programs for cosmetic appearance are excluded from IRC Section 213(d), but treatments for medically diagnosed obesity or comorbid conditions are 100% deductible medical care. The 5 Elements Your Letter of Medical Necessity (LMN) Must Contain: 1. Specific ICD-10 Diagnosis: The letter must state a formal medical diagnosis, such as E66.9 (Obesity, unspecified), E66.3 (Overweight) with comorbidity, or E11 (Type 2 Diabetes). It must never say 'lifestyle weight management'. 2. Objective Biometrics: Baseline BMI (e.g., BMI ≥ 30, or BMI ≥ 27 with hypertension/hyperlipidemia) and vitals recorded by the physician. 3. Medical Treatment Statement: Explicit language stating: "Tirzepatide is prescribed as active medical treatment to mitigate the clinical progression of metabolic disease and cardiovascular risk factors, and is not for cosmetic purposes." 4. Treatment Duration: Specific clinical timeframe (e.g., 12 months ongoing chronic therapy). 5. Physician Credentials: Licensed provider signature, state license number, and National Provider Identifier (NPI). How Telehealth FX Automates This: If you are a Telehealth FX patient, you don't need to draft this yourself. Simply log into your patient portal and click 'Download HSA/FSA Packet'. Our system automatically generates an itemized medical invoice with NDC codes and an automated physician-signed LMN that meets 100% of TPA approval standards. Review our full tax blueprint: [Is Tirzepatide HSA/FSA Eligible? 2026 IRS Compliance Blueprint](/compare/is-tirzepatide-hsa-fsa-eligible/).