Peperomia tetraphylla can be grown in frost free gardens, but in cold climates it is best to grow it as an indoor plant. It is perfect for small containers for a tabletop, a windowsill or in hanging baskets for a patio. It is a slow-growing plant with a small root system, and thus does not need large or deep pots and does not become rootbound. Clay and terracotta pots are the best choice for these plants. In frost free gardens it can be grown in a shade garden, a shady rock garden or in a stumpery (log garden).

Grow Peperomia tetraphylla in bright shade, or medium to bright indirect light, and protect it from direct sunlight. Direct sun will burn the leaves, and too little light will dull its vibrant leaf colours, and stunt its growth, resulting in fewer leaves and no flowers. It prefers to be warm to cool, and not hot. Freezing temperatures will kill the plant. It also prefers a humid environment.

It must be planted in a well-drained, acidic, loose, porous soil medium with added organic matter than retains moisture. Use a sandy, well-drained potting soil for succulent plants, or one designed for epiphytic orchids, and add shagnum moss or peat moss, coarse-milled bark and well-rotted compost and mix it well.

It needs regular watering, but must not always be wet and it is best if it is allowed to dry out before watering again. It is better to keep the plant too dry than too damp. If it receives too much water or is growing in waterlogged conditions, it will develp fungal infections, rot and die. It must be planted in a container that has drainage holes. Do leave the pot to stand in water, rather place the pot on a layer of pebbles. Also try not to water the leaves too often as this may cause fungal problems.

Peperomia tetraphylla can also be grown as an epiphyte on a suitable substrate, such as an old rotting log of wood, or a log with thick, chunky bark on it. The log should be at least 30 cm long and 25 cm thick. Place a layer of moistened moss on the log, and fasten in place with string, fishing net or wire and plant the stems of Peperomia in the moss. Keep moist and feed with organic plant food about once a month.

Peperomia tetraphylla can be propagated by stem cuttings or a mature plant can be lifted and divided. Cut a stem from the plant, take cuttings that are about 10 cm long, remove the lower leaves and either lie the stem on top of the soil or plant it shallowly in the top layer of the soil mix, making sure that there is a node touching the soil. Keep the soil moist and rooting will take place in a few weeks. The stems are delicate and often break during repotting but the broken pieces can be used as cuttings as long as they have at least one node.

Peperomia tetraphylla can be affected by fungal diseases, which can often be prevented by proper ventilation and watering, but can treated with appropriate fungicides. Viral diseases that cause distorted leaves or dwarfism can be treated with Bordeaux mixture. Watch out for slugs that like to eat the leaves, as well as pests like mealy bug, spider mites and aphids. Where the leaf or stem is cracked or scarred, it is best to remove the affected parts as they will not heal.