To explore the microstructure formation mechanism of 42CrMo steel under the strengthening of ultrasonic surface rolling process (USRP), the combination of theoretical analysis and experiment was used to conduct in-depth research on USRP. Firstly, according to contact mechanics and Hertz contact theory, the calculation model of contact stress distribution and elastoplastic strain between the rolling ball and the part during USRP is obtained. Secondly, the USRP processing test was carried out by single-factor experimental design method, and the microstructure of 42CrMo steel after USRP was analyzed by LEXT OLS5100 3D laser surface topography instrument and VEGA3 tungsten filament scanning electron microscopy, which found that with an increase in static pressure, residual stress and plastic strain gradually increase, the hardness firstly increases and then decreases, while surface roughness exhibits an initial decrease followed by an increase. The results show that USRP produces violent plastic deformation inside the material under the superposition of high-frequency impact and static pressure, at the same time, it refines the grains, so as to improve the surface performance of the part and improve its fatigue resistance.