The game is viewed from a horizontal side-scrolling perspective. Players move through eight linear stages, defeat waves of Foot soldiers and monsters, avoid hazards, and defeat a boss at the end of each area. The objective is to reach the end of the Manhattan-centered adventure with limited lives and health.

A player can choose any of the four Turtles. The directional pad moves and crouches, B attacks, and A jumps; pressing A and B together performs a special move at a health cost. Two-player cooperative play allows simultaneous progress, while defeated enemies can drop food that restores health. Each Turtle's weapon gives a different range and rhythm to the basic attack.

Use the Turtle whose attack range suits the stage: Donatello is useful for keeping distance, while Michelangelo and Raphael are effective when enemies crowd the screen. Attack from the edge of an enemy group rather than jumping into its center.

Save the special move for bosses or dangerous groups, because it consumes health. In two-player mode, spread out enough to avoid being surrounded, but stay close enough to revive the other player through continued progress when possible. Learn boss patterns and prioritize enemies that can attack from outside the main group.