Natural capital accounting provides structured information on the flow and value of ecosystem services derived from the stocks of natural assets and shaped by the extent and condition of the ecosystems that generate them. However, there are various approaches to this framework that can be applied at different scales (e.g., national, subnational, and corporate accounts), meaning the methodology remains unstandardised. In the case of mountain natural capital, accounting is further complicated by the unique ecological, social, and economic dynamics of mountain regions, as well as the lack of quality data. For these reasons, mountain natural capital is under-researched, despite its critical role in providing essential services to people and its increasing vulnerability to climate change, land-use change, and other drivers of global change. In this context, we present a review of current methodologies for accounting and assessing natural capital and ecosystem services in European mountain regions, which also consider the effects of global change drivers, based on a bibliographic research and consultations with international experts. This synthesis covers current methodologies to assess each element of mountain natural capital, as well as to identify relevant stakeholders and beneficiaries of these elements. By providing this information, we offer a broader perspective for environmental decision-making, along with recommendations for technical staff to improve the application of natural capital accounting in different contexts. This is particularly crucial in sustainability projects that aim to maintain the functionality of mountain socio-ecological systems in an integrated manner, address current challenges and vulnerabilities, and ultimately enhance their resilience and adaptive capacity.