Tetris 64 is a falling block puzzle which offers the traditional Tetris experience: Blocks enter the screen from the top of the screen and can be moved and rotated as long as they are falling. The goal is to create full lines which then disappear, reward points and cause the game to become more difficult over time. The game is lost when the appearing stone can't be moved anymore because the screen is full. B-Type is similar but the screen gets filled with random block combinations from the ground.

In addition to this standard mode, the game features two unique variants: In "Giga Tetris" the player occasionally has to deal with huge blocks which break up when touching the ground. "Bio Tetris" makes use of the bio sensor accessory which was included with the game: it is clipped into the user's ear and measures the heart rate. It can be set if the game slows down or speeds up when the heart rate rises.