What Is NFPA 99?
NFPA 99 is the Health Care Facilities Code published by the National Fire Protection Association. It is the primary standard governing the safe use of electrical equipment in healthcare settings — hospitals, nursing homes, ambulatory care centers, and other facilities where patients receive care.
The 2021 edition of NFPA 99 (the current version referenced by most CMS regulations) covers a broad range of healthcare facility systems and requirements, including medical gas systems, electrical systems, information technology, and patient care-related electrical equipment. For most healthcare facilities, the chapters on electrical systems and patient care electrical equipment (PCREE) are the most directly relevant to day-to-day operations.
NFPA 99 is not a law by itself — it is a standard. However, CMS has incorporated NFPA 99 by reference into its Conditions of Participation, which means that skilled nursing facilities, hospitals, and other CMS-certified providers are legally required to comply with it as a condition of Medicare and Medicaid participation.
Equipment Categories Under NFPA 99
The 2012 and later editions of NFPA 99 introduced a risk-based categorization system that classifies equipment and systems by the risk they pose if they fail:
Category 1 — Failure of equipment in this category is likely to cause death of patients or caregivers. Life support systems, critical monitoring equipment, and systems in critical care environments typically fall here. Category 1 equipment requires the most stringent testing and maintenance requirements.
Category 2 — Failure is likely to cause minor injury to patients or caregivers, or a major disruption of care. General care area patient care electrical equipment typically falls in Category 2.
Category 3 — Failure is unlikely to cause injury but could result in minor disruption of care. Housekeeping equipment and non-clinical electrical equipment in care areas.
Category 4 — Failure poses no significant risk. General facility equipment in non-care areas.
The categorization matters because it determines which testing protocols apply, which testing intervals are required, and who must perform the testing.
Need NFPA 99-compliant PCREE testing for your facility? Our network connects you with qualified biomedical technicians who perform leakage current, ground resistance, and touchpoint current testing per NFPA 99 standards. For SNF-specific PCREE services, see PCREEtest.com.
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NFPA 99 Chapter 10 covers patient care-related electrical equipment (PCREE) and establishes the electrical safety testing requirements that most healthcare facilities are most focused on. Key requirements include:
Leakage current testing — NFPA 99 sets maximum chassis leakage current limits: 100 microamperes for general care areas, 10 microamperes for critical care areas with direct cardiac access. Equipment exceeding these limits must be taken out of service until repaired and retested.
Ground resistance testing — The ground conductor resistance must not exceed 0.1 ohm for all patient care electrical equipment. Proper grounding is the primary protection against electrical shock if an equipment fault occurs.
Testing frequency — NFPA 99 requires testing before initial use of new equipment and at intervals defined by the facility's written maintenance program (consistent with manufacturer recommendations). Annual testing is the standard adopted by most facilities.
Testing after repair — Any patient care electrical equipment that has undergone repair must be retested before returning to patient care service. This applies to both internal repairs (by a biomedical technician) and external repairs (sent to the manufacturer or an independent repair depot).
New equipment testing — All patient care electrical equipment, even brand-new equipment fresh from the manufacturer's box, must be tested before it enters patient care use. New equipment is not assumed to be safe — manufacturing defects can create leakage current or grounding failures before the device ever touches a patient.
How NFPA 99 Relates to CMS
CMS incorporates NFPA 99 requirements through its Life Safety Code (LSC) survey process and through the equipment maintenance requirements in the Conditions of Participation. For skilled nursing facilities, the relevant CFR provisions (42 CFR §483.90) require compliance with NFPA 99 for patient care electrical equipment.
During CMS surveys, Life Safety Code surveyors specifically look for evidence that PCREE testing has been performed in accordance with NFPA 99 standards. They examine inspection stickers on equipment, review PCREE test reports, and may observe actual testing being performed.
Facilities that are found to be out of compliance with NFPA 99 electrical testing requirements receive deficiencies under F-tag F908 (Electrical Equipment) or related Life Safety Code tags. Depending on scope and severity, these deficiencies can require immediate corrective action and carry the potential for civil money penalties.
Who Can Perform NFPA 99 Testing
NFPA 99 requires that testing be performed by a qualified person. While the standard doesn't define a specific credential requirement, CMS guidance and industry practice require that testing be performed by someone with the appropriate knowledge, training, and calibrated test equipment to perform the tests correctly and document the results accurately.
In practice, PCREE testing is typically performed by: Certified Biomedical Equipment Technicians (CBETs) with CBET certification from the Association for the Advancement of Medical Instrumentation (AAMI/ACCE); biomedical engineers with appropriate training; or biomedical services companies whose technicians have documented training in NFPA 99 testing procedures and whose test equipment is itself calibrated and traceable to NIST standards.
Medical Equipment Repair Network connects healthcare facilities with qualified biomedical technicians for NFPA 99-compliant PCREE testing. For SNF-specific PCREE services, visit PCREEtest.com.
NFPA 99 Compliance Services by State
Maintaining NFPA 99 compliance requires qualified biomedical technicians with the right test equipment and documentation procedures. Find NFPA 99-compliant repair and inspection services in your state:
Written by the Medical Equipment Repair Network editorial team. Medical Equipment Repair Network connects healthcare facilities across all 50 states with qualified local biomedical technicians for repair, calibration, and compliance services.
Frequently Asked Questions
NFPA 99 (Health Care Facilities Code) requires healthcare facilities to test and maintain patient care electrical equipment at intervals per manufacturer specifications, maintain equipment inventories, document all testing with written reports, and use qualified technicians for all testing and maintenance.
NFPA 99 classifies patient care areas as Class I (critical care), Class II (general care), and Class III (wet locations). Leakage current limits are strictest for Class I. Most SNF patient rooms are Class II. The classification determines maximum allowable leakage current thresholds during PCREE testing.
Yes. NFPA 99 applies to all healthcare facilities including skilled nursing facilities. CMS Conditions of Participation incorporate NFPA 99 by reference, making it a federal compliance requirement for all Medicare and Medicaid participating SNFs.