Typical roguelike elements include permadeath, randomized environments, and weapons and items that are often different for each session. Next to the basic coins currency used in a single session to buy items at a shopkeeper, diamonds are a second currency that are gathered across sessions and can be spent at the lobby to access permanent perks. There are many different characters to unlock, each with their own abilities, different zones and multiple game modes. Typical weapons include a broadsword with a long reach, a throwable dagger, bombs, and a shovel to bust through walls quickly. After defeating a certain enemy, often a boss, the exit stairs are unlocked to move to a new level. Often there are optional challenges, for instance to find or buy a key to free someone from a cage, or rewards in exchange for more difficult levels. The game has many types of items and abilities for the main character. The character has a number of hearts, representing health.
The PC version has a level editor with integration through Steam Workshop to create and share new levels. The game has a daily challenge with an identical dungeon for all players and supports local cooperative games with a second player on the same screen. There is a story mode and a basic run of the game consists of four zones with four levels each. The story describes how Cadence, the initial character and the daughter of a famous treasure hunter, has gone missing after she ends up in the crypt of the NecroDancer. Her father steals her heart, which is used to represent the beat at the bottom of the screen, and she needs to defeat him and his minions, while keeping her heart pumping.