Reformed theology, articulated in the Westminster Confession of Faith (1646) alongside modern confessions including the Confession of 1967 and the Belhar Confession, emphasizes the sovereignty of God in all of creation and history, including salvation. The PCUSA's Book of Confessions takes a historically developmental view of doctrine; Scripture, read within the community of faith and interpreted through reason, tradition, and experience, is the primary norm.

Governance is the defining feature of Presbyterian polity. Authority rests with assemblies of ordained elders. The local session governs the congregation. Regional presbyteries (approximately 170) ordain clergy. The General Assembly, meeting every two years, makes binding policy. This representative, deliberative structure means that significant decisions — including the 2014 vote to allow same-sex marriage — move through multiple levels of approval.

The PCUSA has approximately 1.1–1.2 million members in roughly 8,500 churches, reflecting decades of decline from a 1960s peak near 4 million. It is strongest in the Midwest, Mid-Atlantic, and Pennsylvania.

A Sunday PCUSA service is ordered and Word-centered: call to worship, prayer of confession, Scripture from the lectionary, sermon, creed, and often Communion. Music ranges from classic hymnody to contemporary worship. The denomination prizes theological literacy; adult education, seminary networks, and lay study resources reflect a tradition that has always valued the life of the mind in service of the gospel. First-time visitors often find the service structured enough to follow and substantive enough to reward return.