The European Water Framework Directive establishes the need to define stream type-specific reference conditions to identify “high ecological status”. Methods for selecting reference sites using a priori criteria have been proposed by many authors. A review of these criteria revealed that the most relevant criteria for streams and rivers were those related to riparian vegetation, diffuse and point sources of pollution, river morphology and hydrological conditions and regulation. In this work, we propose 20 criteria that reflect the characteristics of Mediterranean streams and their most frequent disturbances for the selection of reference sites in Mediterranean streams in Spain. We studied 162 sites located in 33 Mediterranean basins belonging to five stream types. Of the locations, 57% were selected as a priori reference sites by having applied the proposed criteria. Reference sites were identified for all stream types except for “large watercourses” which includes the lower reaches of some rivers in this study area. This a priori selection of reference sites was subjected to validation using the macroinvertebrate community by applying of an IBMWP threshold, which is considered to be an indicator of undisturbed sites in Mediterranean streams. This approach determined that whole of this selection (100%) could be considered valid reference sites. Furthermore, we identified differences in the reference conditions for each stream type on the basis of macroinvertebrate assemblage composition.