Nonalcoholic steatohepatitis (NASH) is a chronic liver disease associated with metabolic syndrome, such as obesity, diabetes, and hyperlipidemia, and is a progressive form of nonalcoholic fatty liver disease with pathological features including steatosis, lobular inflammation, and hepatocyte damage (ballooning degeneration). Hepatocellular ballooning degeneration is an important pathological feature of NASH and is closely related to the prognosis of NASH patients. Accurate identification of hepatocellular ballooning degeneration is of great significance for diagnosing NASH and assessing therapeutic response. This article reviews the current status and identification methods of hepatocellular ballooning degeneration in NASH, including invasive and noninvasive.