At the end of each game, players are Ranked on their performance, with at least an ' OK' rank required to clear it and progress onto the next. The game is played with the Wii Remote held vertically, with players required to either tap Ⓐ, or 'squeeze' Ⓐ+Ⓑ together. Unlike the previous game, Rhythm Heaven, which utilized the features of the Nintendo DS, Rhythm Heaven Fever for the Wii is limited to button controls. Like previous titles, the game features various Rhythm Games each with their own rules, requiring the player to play in time to the rhythm in order to clear them.
