Twisted Metal is a reboot of the vehicle combat game Twisted Metal (1995). Players race and battle through three new stories that all intertwine with characters such as Sweet Tooth, Mr Grimm, and Doll Face. Players fight new bosses and unfold the characters' dark life stories while unlocking new and old returning vehicles and hidden items.

Racing is introduced as a new game mode to race at high speeds around cliffs falling off or going through crowded suburbs while picking up weapons to finish in first place while keeping from being destroyed by the bombs of Calypso, the creator of the tournament, if you lose. Cage Match is another new mode where the car battles to stay in a small square to keep health from going down if it gets pushed out in such a small area. The game contains all new battle arenas and hidden areas in suburbs, football fields, desert cliffs, and snowy New York. It also contains an arena made by Calypso with fire, spikes, electricity and loads of obstacles.

Cars can be customized to change colors, paint schemes, and mounted weapons such as a gun pistol, shotgun, chaingun and more. Online multiplayer is supported to up to sixteen players in classic free-for-all or in one of the many new mini games. The Nuke mode is a team-based multiplayer mode based around destroying or protecting a giant statue held in the air by a helicopter. The destroying team needs to kill the opposing leader and then sacrifice its own leader to require a missile launcher that damaged the statue. To completely destroy it, the process has to be repeated three times. The available factions are Clowns, the Dolls, the Skulls, and the Holy Men. Split-screen is supported for up to four players.