In this study, we explore the analysis of peristaltic flow with heat transfer occurring within the gap between coaxial inclined tubes. The inner tube’s wall is rigid, while the outer tube’s wall features a sinusoidal wave propagating through it. The cylindrical system is employed to formulate the problem. The flow is characterized using continuity, momentum, and energy equations. We apply the assumption of long wavelength and the low Reynolds number approximation to simplify the nonlinear governing equation, subsequently solving it through perturbation techniques. We investigate the impact of crucial parameters, such as the magnetic field, porous media, slipping conditions, and others, on the peristaltic flow of a couple stress fluid. Our focus lies on assessing their influence on axial velocity, pressure gradient, and flow streamlines. The outcomes are visually presented through graphical representations. Notably, an increase in the slipping parameter results in a reduction of fluid velocity, attributed to the reverse slipping of the flow. The introduction of a magnetic field leads to an augmentation of the pressure gradient. Moreover, elevating the peristaltic amplitude and heat source induces the formation of a vortex within the flow. The presence of porous media leads to an increase in the pressure difference of the fluid flow. The primary objective of this research is to enhance our understanding of the peristaltic motion of non-Newtonian fluid dynamics, specifically incorporating a couple stress fluid. This contributes to a deeper understanding of crucial fluids, such as blood, within the human circulatory system. The implications extend to biological and industrial applications like magnetic resonance imaging (MRI) and radiosurgery, advancing our scholarly understanding of fluid behavior, especially in non-Newtonian scenarios.