Gameplay consists of normal Tetris games. However, there are several game modes, tweaking the way the game works.
Story mode
The goal is to evacuate the homeworld of the Minos before their solar system's sun Hadar goes supernova.
The player can send their Mino Tetrinaut to six different worlds, they play the Tetris variant of that world. When the player plays enough of that world, more Minos are rescued. The better the player does, the more Minos rescued. They will then work to create the world into a home for Minos.
Arcade mode
A four-player game of Tetris Worlds.
This mode is where the player plays two-minute Tetris games of any variant. This is also where multiplayer games are played. The Arcade mode variants are listed as follows:
Tetris: "Go for a Tetris". A normal Tetris game, where the player plays until he/she loses. Losses occur when the Tetriminos reach the top.
Square Tetris: "Go for a Square". While the player plays Tetris, they also must try to combine Tetriminos into squares. Lines cleared containing 4x4 Tetriminos cause large bonuses. This variant originated from The New Tetris.
Cascade Tetris: "Go for a Cascade". The player must try to clear lines that cause Cascades. Cascades occur when a cleared line cause other Blocks to fall and clear another line.
Sticky Tetris: "Clear the Bottom Line". Players must try to clear the bottom line of "Garbage Blocks". Same-colored Blocks stick together in this mode, hence the name. If 25 same-colored blocks connect, a Critical Mass is formed and are cleared from the Matrix. This variant originated from "The Next Tetris".
Hot-Line Tetris: "Go for a Hot-Line". In this mode, there are six "Hot-Lines" in the Matrix. The player must try to clear lines that are on the Hot-Line. Lines cleared anywhere else earn no points.
Fusion Tetris: "Activate the Atom Blocks". In this mode, there is a "Fusion Block" at the bottom of the Matrix. Players must try to connect falling "Atom Blocks" to the Fusion Blocks. Atom and Fusion Blocks are not cleared in line clears, and clearing a line containing an Atom or Fusion Block causes a Cascade.
Popular Tetris (GBA Version Only): In this hidden mode the game is set up like the original Tetris game. The player clears lines to score points and after every 10 lines the level goes up. Scoring increases on higher levels and there is no time limit; however, this mode stops keeping score once a player reaches 1 million (which is more than 999999, the maximum score on the Game Boy version).