As with Rhythm Tengoku and its DS sequel, Rhythm Heaven Fever features various levels with their own set of rules, requiring the player to play in time to the rhythm in order to clear them. These levels range from stabbing peas with a fork, to attacking evil spirits with a sword, and playing badminton in midair. The game is played by either tapping the A button, or squeezing the A and B buttons together. At the end of each level, players are ranked on their performance, with at least an 'OK' rank required to clear the level and progress onto the next. Each set of levels culminates in a Remix stage, which combines all of the gameplay elements of the previous levels in one stage. Clearing levels with a Superb rating earns medals that unlock extra content, including Rhythm Toys, Endless Games and four levels from the original Rhythm Tengoku, plus a bonus credits level. Levels that have been cleared with a Superb rating may also be randomly selected for a Perfect attempt, in which the player can try to clear the level without making any mistakes with a maximum of 3 retries before the perfect challenge disappears. Clearing these unlock bonus items such as songs and lyrics. The game also features a Dual Mode in which two players can play simultaneously. Levels played in this mode require players to earn enough points in total to reach the desired rank and clear each stage, with bonus points awarded based on the harmony of the players that can improve the rank. These levels come with their own set of medals which can unlock multiplayer minigames.