The results of a phytosociological investigation regarding the orophilous cushion-like vegetation occurring in the top of the high mountains of central-southern Greece and in some Ionian (Lefkas, Cephalonia) and Aegean Islands (Euboea, Samos, Lesvos, Chios and Thassos) are provided. Based on 680 phytosociological relevès (460 unpublished and 220 from literature), a new syntaxonomical arrangement is proposed with the description of a new class, including two new orders, eight new alliances, and several associations (many of them new). Compared to the previous hierarchical framework usually followed in the literature, this study provides a more realistic and clear phytosociological characterization of this peculiar and archaic vegetation type, which is exclusive to the high mountains of the north-eastern Mediterranean. The new arrangement is mainly based on the phytogeographical role of the orophytes featuring this very specialized vegetation, which is essentially represented by endemics or rare species belonging to the ancient Mediterranean Tertiary flora. In addition, taxonomic research on the orophilous flora occurring in these plant communities allowed to identify six species new to science (i.e., Astragalus corinthiacus, Allium cremnophilum, A. cylleneum, A. orosamium, A. karvounis, and A. lefkadensis) and a new subspecies (i.e., Allium hirtovaginatum subsp. samium), and two new combinations (i.e., Astragalus rumelicus subsp. euboicus and subsp. taygeticus) are proposed.