Given the significant role of advancing comprehensive reform of agricultural water pricing in promoting the sound operation of farmland water conservancy projects, promoting agricultural water conservation, achieving efficient utilization of water resources, and ensuring national food and water security, this paper conducts a systematic analysis of reform policy documents and a thorough review of typical reform cases over the years. It provides an overall assessment of the general progress, institutional changes, mechanism development, typical practices, and notable achievements of China’s comprehensive reform of agricultural water pricing. In view of the prominent issues currently facing the reform, recommendations are proposed, such as further verifying the baseline data of the reform, carrying out extensive sampling surveys, establishing a follow-up mechanism, reimbursing operation and maintenance costs, and setting up a water price compensation mechanism.