The Cross of Honor was designed by Mary Erwin and Sarah Gabbett, of the United Daughters of the Confederacy in 1898 and awarded to members of the United Confederate Veterans starting in 1900 for honorable service in the Confederate States Army, Navy or Marine Corp. As only living veterans were eligible for the award nearly 79,000 were given out over the 59 years of the program.

While wearing the medal was never authorized on US military uniforms Virginia law made it a class 3 misdemeanor to wear the medal when not entitled to do so by the regulations under which such Crosses of Honor are given.

The Cross of Honor is also used by the Department of Veterans Affairs to mark the graves of Confederate soldiers. The Cross of Honor can also be seen on numerous memorials and monuments.