Beyond the four historic Eastern patriarchates, later Orthodox churches have themselves been raised to patriarchal rank as their national or regional churches grew in size and political standing, a process governed by the Orthodox principle of autocephaly, literally self-headed, under which a church becomes fully self-governing, electing its own primate without requiring another church's ongoing approval, subject only to being recognized as legitimately autocephalous by the wider communion of Orthodox churches. The Patriarchate of Moscow, raised from a metropolitanate in 1589, and the patriarchates of Serbia, Romania, Bulgaria and Georgia, elevated at various points between the medieval period and the twentieth century, represent this later expansion of patriarchal rank beyond the ancient pentarchy.
Not every autocephalous Orthodox church is headed by a patriarch: several, including the Church of Cyprus and the Church of Greece, are self-governing at the same juridical level as a patriarchate while their primate holds the title archbishop rather than patriarch, a difference of honorific title rather than of underlying authority. Recognition of autocephaly has occasionally been contested between Orthodox churches, as with the Ecumenical Patriarchate's 2019 grant of autocephaly to a new Orthodox Church of Ukraine, which the Moscow Patriarchate has not accepted, illustrating that patriarchal rank and autocephalous status, though closely related, are conferred and recognized through a communion of churches with no single central authority to settle every dispute.