Multispecies risk assessments have developed within many international conservation programs, reflecting a widespread need for efficiency. Under the United States Endangered Species Act (ESA), multispecies assessments ultimately lead to species-level listing decisions. Although this approach provides opportunities for improved efficiency, it also risks overwhelming or biasing the assessment process and would benefit from clear guidance for practitioners. We reviewed multispecies assessments conducted between 1993 and 2019 for ESA listing decisions to identify the ecological basis for combining species, the assessment approach used, and the policy factors influencing their efficacy. We identified 42 cases covering 359 species. Most assessments (81%) included two to five species, although the maximum was 82. A common theme involved grouping narrow endemics or habitat specialists based on taxonomic relatedness, similar distributions, and common threats to persistence. All assessments included a combined threats analysis, but few employed a common species' response model or expert elicitation process. Although ESA risk assessments are distinct from policy decisions, most assessments (50%) supported decisions that all species warranted endangered status. Available guidance has generally emphasized ecological similarity as the key attribute leading to successful multispecies assessments. The challenge with consistently selecting species based on qualitative proxies such as common distributions or threats to persistence is that ecological patterns and processes are scale dependent. Focusing instead on the assessment methods and their potential for bias and increased efficiency may provide a stronger basis for developing consistent and transparent guidance.