Typically rhythm games rely on timed input according to on screen cues and tempo. Mad Maestro features this style of gameplay, with the additional layer of pressure sensitivity. Utilizing the pressure sensitivity with the DualShock 2, the player must conduct an orchestra by tapping correlating buttons with varying degrees of pressure. There are three levels of pressure; light, medium and hard. By playing good and increasing their score, the player can reach Bravo Mode, which is required to beat the stage. By playing 3 or more notes bad however, the player is forced into Devil Mode, where their score will fall until they play a correct cycle perfectly. The Japanese release featured an optional Baton peripheral.