HyperbaricStore guide
NFPA 99 for Hyperbaric Facilities: State Requirements
NFPA 99 is the Health Care Facilities Code. For hyperbaric projects, its Chapter 14 requirements are concerned with the facility around the chamber: electrical systems, fire protection, pressure and gas hazards, construction, operation, and inspection, testing, and maintenance.
NFPA 99 is a consensus code, not a federal product certificate. It becomes enforceable when a state or local jurisdiction adopts it, when another adopted code references it, when a facility is subject to a federal program, or when it is made part of a project’s contractual or accreditation requirements.
There is no single national “NFPA 99 state list.” The enforceable answer depends on the state edition, amendments, occupancy, facility license, project date, and authority having jurisdiction.
What Chapter 14 brings into the project
The 2024 NFPA 99 publication includes Chapter 14, Hyperbaric Facilities. Its scope addresses the electrical, fire, pressure, and gas hazards associated with hyperbaric facilities used for medical, therapeutic, and experimental procedures. The project team uses the chapter together with the adopted building, fire, electrical, mechanical, medical-gas, and health-facility requirements.
In practical terms, the review may cover chamber classification, room construction and separation, clearances, ventilation, oxygen-enriched atmospheres, electrical equipment and grounding, medical-gas supply and piping, fire protection, emergency procedures, staff training, and inspection, testing, and maintenance. The exact requirements depend on the chamber, the care category, the installation, and the edition adopted by the AHJ.
How states make NFPA 99 enforceable
- State building or fire code adoption. A state code may directly say that hyperbaric facilities must meet Chapter 14 of NFPA 99, or may adopt an International Code section that does so.
- Health-facility licensing. A department of health may incorporate NFPA 99 into hospital, ambulatory-care, or other licensed-facility construction and operation requirements.
- Local enforcement. Even with a state code, the building official, fire marshal, health department, or other AHJ reviews the specific project and local amendments.
- Federal participation. Facilities participating in Medicare or Medicaid may have a separate CMS compliance obligation. CMS currently identifies the 2012 NFPA 99 Health Care Facilities Code, with stated exceptions, for covered providers and suppliers.
State and jurisdiction examples
The following official references show how NFPA 99 is used in different regulatory layers. They are examples verified for this guide, not a promise that every project in the state follows the same edition or review path.
| State or jurisdiction | Official reference | What it shows |
|---|---|---|
| California | 2025 California Building Code, §§ 1224.4.6.3 and 1224.39.5 | Clinical hyperbaric therapy service space and hyperbaric facilities must meet NFPA 99 plus California-specific space and clearance provisions. |
| New York | 2025 Building Code of New York State, § 425.1 | Hyperbaric facilities are directed to meet Chapter 14 of NFPA 99. |
| Ohio | 2024 Ohio Building Code, § 425.1 and 2025 Ohio Fire Code, § 609.1 | Design is directed to Chapter 14, while inspection, testing, and maintenance are directed to NFPA 99. |
| North Carolina | 2024 North Carolina Building Code, § 425.1 | Hyperbaric facilities are directed to meet Chapter 14 of NFPA 99. |
| Minnesota | Minnesota State Fire Marshal interpretation | The state explains that mild hyperbaric oxygen therapy chambers and their facilities fall under the applicable fire-code provisions and references the 2012 NFPA 99 adoption for hyperbaric facilities. |
| Alaska | 2021 Alaska International Existing Building Code, § 302.2.1 | Alterations, repairs, additions, changes of occupancy, or relocation involving certain existing hyperbaric facilities must also comply with NFPA 99. |
CMS and the 2012 edition
CMS states that certain Medicare- and Medicaid-participating providers and suppliers must meet the 2012 editions of NFPA 101 and NFPA 99, with the exceptions and conditions described in its regulations and guidance. That federal compliance layer is separate from a state’s adoption of a newer or older edition. A facility can therefore need to reconcile state code, CMS requirements, and local amendments instead of assuming that the newest NFPA publication automatically controls.
NFPA 99 planning checklist
- Identify the destination state, municipality, facility type, occupancy, and planned use of the chamber.
- Ask the building official, fire marshal, health department, and medical-gas reviewer which NFPA 99 edition and amendments apply.
- Confirm whether the facility participates in Medicare or Medicaid and review the applicable CMS requirements.
- Classify the chamber and level of care with the project’s qualified design professional; do not copy a classification from another installation.
- Coordinate chamber drawings with room layout, rated construction, access and clearances, ventilation, oxygen supply, electrical systems, fire protection, alarms, and emergency procedures.
- Prepare an inspection, testing, maintenance, and training plan before opening the facility.
- Keep the final code matrix, approved drawings, inspection records, manufacturer documents, and AHJ approvals with the facility record.
What this means for a chamber purchase
Give the manufacturer the destination and intended use early. A chamber that fits a room dimensionally may still require different electrical, gas, fire, ventilation, clearance, or inspection provisions at the destination. Request the chamber’s technical documentation, pressure-vessel certifications, utility requirements, and installation assumptions so the design team can review them against the adopted code before the purchase is final.