Rhythm Heaven Fever is the third in the series of rhythm-based music games by Nintendo. As with the previous games in the series, the game is based around precise timing and listening, rather than watching for visual cues. A player should ideally be able to play the game solely based on the audio cues given within each level's song.

Unlike the stylus-based inputs of Rhythm Heaven, Rhythm Heaven Fever returns to the more precise button taps that the original Rhythm Tengoku used. The A and the B Buttons are the only inputs used for each level (usually only the A Button), and players must carefully time their presses to progress through each level. As with the previous games, you're given a rank at the end of each level, based on how good your timing was, either "Fail", "Pass" or "Excellent". If you earn an "Excellent" rank on the level, it becomes available for the "Perfect" challenge, which appears randomly. In the "Perfect" challenge, you have three attempts to complete the level without missing a single beat. Successfully earning "Perfect" unlocks special rewards.

Rhythm Heaven Fever uses a simplistic, but creative visual style, with each level being quite unique from the other. One moment you could be high-fiving monkeys in a gigantic pocket watch, the next you could be playing badminton with a dog and a cat flying in planes through a cloudy sky.