Miami in the '80s: gangs, drugs and hookers dominate the scene and a Cuban called Tony Montana rises up to be the most powerful drug dealer, controlling the whole of Miami. This is the story of the 1983 movie Scarface in which Tony Montana dies during a attack from a rival gang on his mansion at the end. The game now puts the player in the shoes of Tony a few moments before the gang hits his office.

After he successfully defends his mansion, his empire lies in ruins. But Tony wouldn't be Tony Montana if he would just give up, so it is the player's goal to reclaim Miami once again. To do so, he has to earn money and respect. The only way to earn money in Miami is to deal drugs. At the beginning the stuff is bought in small amounts and personally sold to the dealers. Eventually, however, Tony can set up so-called "Fronts" which are legitimate shops (like a car seller) in which drugs are sold in very large amounts. By overtaking "Fronts", Tony also increases his control over the current district of Miami. To completely overtake one part of town, all the enemy gangs scattered around in small groups must be eliminated.

After a deal, Tony has to launder the money at the local bank and have it transferred to his account. He then can buy "exotics" for his mansion like an expensive vase or a new car with a driver.

When talking with a dealer or trying to get cop heat down, the player has to play a mini-game that determines if Tony is successful and if so, how much he gets for the drugs or how much heat he loses.

Respect is earned by increasing Tony's territory, buying exotics and earning "balls" in fights and while driving. The enemies have different target zones which give a different amount of balls on a hit. This also fills up Tony's 'ball-meter". Once this is full he can enter a kind of god mode in which he is invulnerable and has unlimited ammo. Tony also gets health when killing someone in this mode. If he is driving a car he gets balls when making stunts like driving on the wrong side of the road or dodging an incoming car.

As in Grand Theft Auto: Vice City, the player is free to roam the city of Miami and there are also some side-missions with racing events.