What Is an F-Tag in Nursing Homes and How Does It Work?

An F-tag is the code a state inspector assigns to a nursing home when the facility violates a specific federal care regulation. Each tag ties to a numbered requirement in Title 42 of the Code of Federal Regulations, Part 483, the rules a nursing home must follow to accept Medicare and Medicaid.¹ There are more than 200 F-tags in use, covering everything from handwashing to resident rights, and every one that gets cited becomes part of the facility’s public inspection record.²

The tags themselves are shorthand. Inspectors don’t invent what to look for on the day of the visit. CMS publishes a manual called Appendix PP that explains, tag by tag, what surveyors should observe, what questions to ask residents and staff, and what evidence supports a finding of noncompliance.³

How a Citation Gets Assigned

State survey agencies inspect nursing homes on behalf of CMS.⁴ Standard surveys are unannounced and land between 9 and 15 months after the last one, averaging about 12 months per facility. During the visit, inspectors watch how staff work with residents, pull medical records to check whether care matches physician orders, interview residents and family members, and review personnel files for training and background checks. Anything that falls short of the regulation gets recorded, with the matching F-tag, on Form CMS-2567 — the Statement of Deficiencies.⁵

Citations also come from complaint investigations. A complaint alleging immediate jeopardy triggers an on-site visit within two to seven business days. High-priority complaints without immediate jeopardy get an average 15-business-day response, and medium-priority complaints must be investigated within 45 calendar days. Lower-priority reports are tracked and reviewed at the next scheduled survey.

Severity and Scope: What the Letter Grade Means

Every citation gets a letter from A to L that reflects two things at once: how serious the harm is, and how many residents it reaches.⁶ The letter matters more than the F number when you’re trying to gauge how bad a citation is.

Severity has four levels. Level 1 is potential for minimal harm — the facility is out of compliance but the risk is slight. Level 2 is potential for more than minimal harm; no one has been hurt yet, but the risk is real. Level 3 is actual harm to one or more residents that stops short of a life-safety threat. Level 4 is immediate jeopardy: noncompliance that has caused or is likely to cause serious injury, impairment, or death.⁷

Scope has three levels: isolated (one or a few residents), pattern (multiple residents but not the whole facility), and widespread (systemic, affecting the facility as a whole). Where severity and scope intersect on the grid produces the letter grade. An A rating is the mildest form of noncompliance. An L rating — widespread immediate jeopardy — is the most severe.

One threshold on this grid carries a special name. A deficiency at level F, H, I, J, K, or L counts as substandard quality of care, which brings extra enforcement consequences on top of the base penalty for the citation itself.²

The F-Tags Facilities Get Cited For Most

A handful of tags dominate inspection reports across the country. Based on CMS CASPER data from 2025, these are the ones cited most often:

F880, infection prevention and control: handwashing, isolation practices, sanitary procedures.⁸
F812, food safety: how food is purchased, stored, prepared, and served.
F761, drug labeling and storage.
F689, accident hazards and adequate supervision.
F656, comprehensive care plans — one plan, individualized, for every resident.
F684, quality of care: a broad requirement that each resident receive the care needed to reach or maintain the highest practicable level of functioning.
F550, resident rights: the right to be informed, to make decisions, and to participate in care planning.

Infection prevention has topped or near-topped the list since the early 2020s. Repeat citations in any of these categories push a facility toward the substandard quality of care designation and the enforcement steps that come with it.

What Happens After a Citation

Once a facility receives its Statement of Deficiencies, it has 10 calendar days to submit a Plan of Correction. The day of receipt counts as Day 0, and the clock starts the next day.⁹ The plan has to explain, for each F-tag, what was done for affected residents, how the facility will find others at risk, what policies or training will change to prevent a recurrence, how the fix will be monitored, and when each step will be complete. Submitting a plan is not an admission that the deficiency occurred; it is a mandatory response.

Civil Money Penalties

CMS can fine a facility either per day the violation continues or per instance. The per-day ranges set in regulation are adjusted for inflation every year.¹⁰ The base statutory ranges are $500 to $4,000 per day for lower-tier deficiencies tied to procedural or structural problems, $1,500 to $8,500 per day for repeat or condition-level care problems short of immediate jeopardy, and $8,500 to $10,000 per day for immediate jeopardy. After inflation adjustments, the current maximum per-day penalty for an immediate jeopardy deficiency reaches $27,378.¹¹ Per-instance penalties, used when a specific episode was corrected during the survey, run a base $1,000 to $10,000 before adjustment.

Denial of Payment for New Admissions

If a facility is not back in substantial compliance three months after the survey that identified the problem, CMS must stop Medicare and Medicaid payment for any new admissions. The same mandatory denial applies when a facility gets substandard quality of care citations on three surveys in a row.¹² Payment resumes only after a revisit confirms the fix is in place.

Termination

In the worst cases, CMS ends the facility’s Medicare or Medicaid participation entirely. Where immediate jeopardy exists and is not removed, termination must happen no later than 23 calendar days from the last day of the survey.⁹ Outside of immediate jeopardy, CMS gives at least 15 days’ notice.¹³ Losing the provider agreement means the facility can no longer accept Medicare or Medicaid residents, which for most nursing homes forces closure.

Where Citations Show Up Publicly

F-tag citations are not internal paperwork. CMS-2567 reports must be publicly available within 14 days after a facility receives them.¹⁴ You can look up any Medicare- or Medicaid-certified nursing home’s citation history on the Care Compare tool at medicare.gov.

The same citations feed the facility’s health inspection star rating, one of three components of its five-star score. The rating draws on the two most recent annual surveys along with complaint and focused infection control surveys from the past 36 months.¹⁵ Each cited deficiency contributes points weighted by its severity and scope: a Level L deficiency is worth 150 points, while a Level D is worth 2.⁶ Newer surveys carry more weight than older ones. A facility that receives an abuse citation at harm level or higher in the most recent cycle has its health inspection rating capped at two stars regardless of its point total.

Challenging a Citation

A facility that thinks a citation is wrong has two dispute options. Informal Dispute Resolution (IDR) is available for any cited deficiency and is handled by the state survey agency. Independent Informal Dispute Resolution (IIDR) uses a reviewer outside the state agency and is available when CMS has imposed a civil money penalty and the deficiency is rated D or higher. A facility can pursue both. While a citation is under dispute, it is excluded from the facility’s Care Compare star rating calculation.¹⁵

1
eCFR. 42 CFR Part 483 – Requirements for States and Long Term Care Facilities
2
CMS. List of Revised FTags
3
Centers for Medicare & Medicaid Services. Medicare State Operations Manual Appendix PP
4
Centers for Medicare & Medicaid Services. Quality, Safety and Oversight – General Information
5
Centers for Medicare & Medicaid Services. Statement of Deficiencies and Plan of Correction – CMS-2567
6
CMS. SFF Scoring Methodology
7
eCFR. 42 CFR 488.301 – Definitions
8
Centers for Medicare & Medicaid Services. QSO-24-08-NH
9
CMS. Nursing Home Enforcement – Frequently Asked Questions
10
eCFR. 42 CFR 488.845 – Civil Money Penalties
11
Federal Register. Annual Civil Monetary Penalties Inflation Adjustment
12
eCFR. 42 CFR 488.417 – Denial of Payment for All New Admissions
13
eCFR. 42 CFR 489.53 – Termination by CMS
14
Centers for Medicare & Medicaid Services. Release of CMS-2567 – Statement of Deficiencies and Plan of Correction
15
Centers for Medicare & Medicaid Services. Design for Care Compare Nursing Home Five-Star Quality Rating System – Technical Users Guide