NFPA 99 Medical Gas for Healthcare Facilities [Changes You Need to Know Today]

Posted by Tim Richards on April 25, 2019
Tim Richards


NFPA 99 Healthcare Facilities code provides performance criteria for healthcare facilities that follow a risk-based approach, where it is the risk posed to patients, staff or visitors, that defines safety guidelines. The main criteria of the Code's scope is to keep healthcare facilities up-to-code with its occupants safe.

As a leader in the control, management, and monitoring of medical gas systems, CHT is asked frequently, in regards to NFPA 99 Healthcare Facilities Code,

"What Applies to My Facility"? 

Medical Gas Systems Cover 

Want to learn more about medical gas systems? Get the definitive guide

Get the PDF version that you can save to your desktop and read it when it's convenient for you.

(No email required):

Yes! Give me my PDF


Understanding and interpreting an NFPA code can often leave facility manager’s
scratching their head. Requirements are not always so black and white and
determining which edition of the NFPA code applies to your facility can be a
frustrating endeavor.
Moreover, once the correct interpretation of the code has been established, there is still the question of its application to your individual scenario. Risk assessments must be performed to determine the correct category and level of care provided and the corresponding application.
Applying NFPA 99 varies depending on the level of care required and provided. 

NFPA 99 (Recent History 

Since July 5, 2016 the Centers for Medicare and Medicaid Services (CMS) has
adopted the 2012 edition of NFPA 99. From a medical gas compliance perspective, this is the edition to which facilities are held accountable.
However, since NFPA 99 is not intended to be a retroactive code, only select portions of NFPA 99-2012 shall apply to systems existing prior to the July 5, 2016 adoption. Specifically, the inclusion of NFPA 99-2012 Tentative Interim Amendment (TIA) 12-4, outlines the sections that apply to both new and existing construction.
Similarly, much of the criteria in TIA 12-4 can also be found in The Joint Commission Hospital Accreditation Standard, EC.02.05.09. It should be noted, however, that individual AHJ’s (authorities having jurisdiction) are permitted to adopt subsequent editions of NFPA 99 for the purposes of new construction.

Annual Evaluation of Medical Gas System 

When performing an annual evaluation of your medical gas system, it is important
to know which sections of NFPA 99 apply. This will require a thorough understanding of your risk category, as well as historical knowledge of your facility since any pipeline alterations, renovations or modernizations may impact the application.
For example, if an older facility had a portion remodeled and the pipeline is breached, the area in the immediate vicinity would need to be installed to the most recently adopted edition of NFPA 99 for that jurisdiction.
Conversely, the older portions of the systems not meeting the 2012 edition may still be acceptable to the AHJ as long as their continued use does not present a distinct hazard to life. In either scenario, a comprehensive understanding of your facility and its relationship with NFPA 99 is vital.
Knowing which sections of your facility may require upgrades can be beneficial for infrastructure budgeting, and ensuring the smooth operation of your medical gas system for years to come.

Current NFPA 99 HealthCare Facilities Code - 2018 Edition  

Changes in the 2018 edition help you work more efficiently to ensure healthcare safety.  

Here are some of the details that will be required under the NFPA 99-2018 code that are different from earlier versions. Cites are from the code currently.

1. Oxygen Concentrators

Chapter 5 includes requirements that now allow for the use of oxygen concentrators as central supply sources for piped medical gas systems.* Oxygen Concentrator Supply Units. states Oxygen concentrator supply units for use with medical gas pipelines shall produce oxygen meeting the requirements of Oxygen 93 USP or Oxygen USP.

What it means...

The 2018 edition adds requirements for onsite oxygen production by a concentrator. Oxygen concentrators are and continue to be, limited in use for most facilities in the United States. Remote areas, such as Hawaii, Alaska, and other island territories implementing NFPA 99 will now have some guidance on their use.

Background on why that change has been made...

The technology behind these supply sources is nothing new and their use has previously been part of the ISO Standard, but is now addressed by NFPA.

How the change may impact the present or future design of medical gas and vacuum systems...

Ultimately, this addition to the 2018 code will have little to no impact on most facilities within the United States since a majority of hospitals are supplied by a traditional cryogenic fluid central supply system (previously referred to as a bulk cryogenic liquid system).

2. Vacuum Filtration

The detailed requirements for vacuum filtration are defined in the code. The filters are required to be as efficient as HEPA (0.3μ (microns) and 99.97% high efficiency)

What it means...
Medical-Surgical Vacuum Central Supply Systems now require inlet filtration on
the patient side of the vacuum producer.
Background on why that change has been made...
While the science is still out and more data is required, there has been a
concern that infectious or other hazardous materials may be transmitted from
the patient terminal back to the supply source. The addition of this filtration is
to alleviate some of those potential concerns.
How the change may impact the present or future design of medical gas and vacuum systems...
Manufacturers will need to incorporate these filtration requirements into the
design of their new vacuum systems. 

3. Corrugated Medical Gas Tubing Corrugated medical tubing (CMT) is now a permitted material for medical gas and vacuum systems.

What it means...

The additional inclusion of corrugated medical tubing will allow installers another piping option, particularly for difficult installations. Ease of installation, reduced cost, and less chance of contamination are benefits that are invaluable for healthcare facilities. CMT is a fabricated tubing with flexibility making it ideal for retrofits and new construction.

Kevin Hoben, OmegaFlex® CEO, a global manufacturer of metal hoses, says

"Copper tubing has always been costly to install with countless brazed sections that make a system vulnerable to leaks and contamination. MediTrac comes in one, long length to eliminate hot work, and its unique design makes it easy to bend as needed to fit a space." 

MediTrac is fully compliant with NFPA 99 (2018) code. 

Background on why that change has been made...

This is a new technology for medical gas piping.

How the change may impact the present or future design of medical gas and vacuum systems...

Corrugated medical tubing's usage can be beneficial, particularly for the installation of positive pressure piping in pre-existing construction. It can reduce the number of installed joints and aid in installations where space or brazed joints can be difficult.

How to implement the change...   

Contact your installer to see if CMT tubing would be beneficial to your next project.

4. The Addition of Chapter 15: Dental Gas and Vacuum Systems

This chapter was added specifically to dental gas and vacuum systems to address their precise needs.  

What it means...

With the previous changes to NFPA 99, particularly as it relates to the change from an occupancy-based document to a risk-based standard, there were some issues with requirements for dental facilities, which were historically addressed as a Category 3 system.

Background on why that change has been made...
Since Category 1 procedures can be performed in a dental setting,
the need for an expanded chapter was necessary. Now, within a dental setting,
NFPA addresses Categories 1-3.

How the change may impact the present or future design of medical gas and vacuum systems...

This change will allow for a more detailed understanding and implementation of NFPA 99 for all manner of dental system installations.  

5. "Governing Body" Wording

In addition, we are seeing a global change in the 2018 edition. 

The term "governing body" is changed to "healthcare facility's governing body". This is to help clarify or highlight the intent. Governing body represents the people who are responsible for the operation of the healthcare facility.   




National Fire Protection Association, Highlight Clip - NFPA 99, Healthcare Facilities code - 2018 Webinar, via YouTube


NFPA 99 2012 edition is currently adopted by the federal government at the time of this writing.

While medical gas changes in the 2018 edition are relatively easy to understand, it is a reminder that technology is always evolving. And even more changes will be forthcoming in the 2021 edition of NFPA 99.

As these codes develop, CHT will keep you informed.

For help in determining how to apply NFPA 99 to your facility, contact your
CHT representative today. Our knowledgeable staff can assist in navigating through
NFPA 99. 


Tim Richards

Tim Richards

Technical Director at CHT Healthcare
Tim has been working in the medical gas industry since 2002, and is dedicated to establishing long-term relationships by surpassing the needs of his clients. Tim holds a BS in Biology from Concordia University Wisconsin, maintains ASSE Medical Gas certifications as an Installer, Verifier, and Instructor.