Unlike most pinball games, the object of Mile High Pinball is to advance to the top of a stack of over 80 table by flipping the ball higher and higher. Each themed table has an objective that must be met before the player can go up to the next table, while draining a ball merely drops the player back down to the previous level. The player can also find hidden doors leading to secret levels, collect money to purchase various Power Ups, or sell them back for money to get other stuff. Players' scores were tracked on the N-Gage Arena, along with online two-player simultaneous play, and a "Try My Board" feature allowed players to rearrange the tables and then post them for others.
Mile High Pinball demonstrates the following tropes:
- Cosmetic Award: At the start of each game, the player can choose a skin for his pinball. The choice has no effect on the gameplay whatsoever.
- Equipment-Based Progression: You can't advance your pinball's abilities, but you can collect Bucks and purchase Power Ups for it.
- Level Editor: A variation — you couldn't edit the game's tables, but you could rearrange them to an easier (or harder) sequence.
- Mutually Exclusive Powerups: Only one Power-Up can be in effect at any time.
- Shout-Out: The hidden levels pay tribute to other N-Gage games, such as a "Pathway to Glory" table that require destroying a tank.