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Sega Tetris is reminiscent to Sega's earlier Tetris titles, featuring a similar rotation system, changing backgrounds, and a monkey as the primary mascot.

In single player, there are three available difficulties, easy, normal, and difficult. There is also an option to play with join block mechanic from the battle mode.

There is also a new mode called "UFO Catcher" it is a minigame available to play from the main menu. After earning virtual currency during regular gameplay, the player can spend it by playing this minigame to unlock playable characters. The minigame works similarly to UFO catchers found in Japanese game centers.