Stream bioassessments rely on taxonomic composition at sites compared with natural, reference conditions. We developed and tested an observed/expected (O/E) predictive model of taxonomic completeness and an index of compositional dissimilarity (BC index) for Central Appalachian streams using combined macroinvertebrate datasets from riffle habitats in West Virginia (WV) and Kentucky (KY). A total of 102 reference sites were used to calibrate the O/E model, which was then applied to assess over 1,200 sites sampled over a 10-year period. Using an all subsets discriminant function analysis (DFA) procedure, we tested combinations of 14 predictor variables that produced DF and O/E models of varying performance. We selected the most precise model using a probability of capture at >0.5 (O/E₀.₅, SD = 0.159); this model was constructed with only three simple predictor variables--Julian day, latitude, and whether a site was in ecoregion 69a. We evaluated O/E and BC indices between reference and test sites and compared their response to regional stressors, including coal mining, residential development, and acid deposition. The Central Appalachian O/E and BC indices both showed excellent discriminatory power and were significantly correlated to a variety of regional stressors; in some instances, the BC index was slightly more sensitive and responsive than the O/E₀.₅ model. These indices can be used to supplement existing bioassessment tools crucial to detecting and diagnosing stream impacts in the Central Appalachian region of WV and KY.