Objectives: Codon usage bias is a fundamental feature of gene expression that can influence evolutionary processes and genetic diversity. This study aimed to investigate the mitochondrial codon usage characteristics and their driving forces in three Medicago species: Medicago polymorpha, Medicago sativa, and Medicago truncatula. Methods: The complete mitochondrial genome sequences of the three species were downloaded from GenBank, and 21 shared coding sequences were screened. Codon usage patterns were analyzed using CodonW 1.4.2 and CUSP software. Key parameters, including the relative synonymous codon usage (RSCU), effective number of codons (ENC), codon adaptation index (CAI), codon bias index (CBI), and frequency of optimal codons (Fop), were calculated. Phylogenetic trees and RSCU clustering maps were constructed to explore evolutionary relationships. Results: The GC contents of the mitochondrial genomes followed the order of GC1 > GC2 > GC3. ENC values averaged above 35, while CAI, CBI, and Fop values ranged from 0.160 to 0.161, −0.078 to −0.076, and 0.362 to 0.363, respectively, indicating a weak preference for codons ending with A/U. Correlation and neutrality analyses suggested that codon usage bias was influenced by both mutation pressure and natural selection, with natural selection being the dominant factor. Fifteen optimal codons, predominantly ending with A/U, were identified. Phylogenetic analysis confirmed the close relationship among the three Medicago species, consistent with traditional taxonomy, whereas the RSCU clustering did not align with the phylogenetic relationships. Conclusions: This study provides insights into the mitochondrial codon usage patterns and their evolutionary determinants in Medicago species, highlighting the predominant role of natural selection in shaping codon usage bias. The findings offer a foundation for comparative genomic studies and evolutionary analyses and may be beneficial for improving genetic engineering and breeding programs of Medicago species.