Hell Passes are unlockable extra difficulty levels for more experienced players, accessible at character select before starting a run. Each Hell Pass adds a modifier that affects the difficulty of the gameplay. You can toggle on Hell Passes individually. When the game is cleared on Normal mode for the first time, Hell Pass 01 is unlocked. Beating the game with the highest level Hell Pass active will unlock the next. The highest level Hell Pass currently in the game is 14.
| Hell Pass Level | Icon | Description | Notes |
|---|---|---|---|
| 0 | 
|
Normal game mode. | |
| 1 | 
|
Enemies start with random artifacts. | Enemy artifacts include:
This modifier may affect all enemies in encounters, bosses, and enemies summoned mid-combat. Structures do not count. Not all enemies will start with an artifact. |
| 2 | 
|
More obstacles and hazards. | This increases the chance of obstacles and hazards (such as Volcanoes and naturally-occurring SD turrets) appearing for every vacant tile on the field. This chance is added upon Luck and how it affects the spawning of hazards and obstacles as well. This caps out at 45 Luck, where this chance is 6.3%, in comparison to normally being capped at 5.0% at 51 Luck. |
| 3 | 
|
Lower defense, no aim marker. | Player loses 5  Defense. This modifier also removes the aim marker present 4 tiles away from the player character; effectively the same as turning it off in Settings.
|
| 4 | 
|
Spared bosses healing halved (1/2) | As of v1.2, spared bosses now heal the player for half of their original value (400 → 200) instead of no longer healing the player. |
| 5 | 
|
Max HP is reduced. | Starting maximum HP is reduced by 25% of original value. |
| 6 | 
|
Enemies start with 2 random artifacts. | Overwrites Hell Pass 1. |
| 7 | 
|
Luck starts at 20. | See  Luck.
|
| 8 | 
|
Enemies regenerate health. | Enemies heal equal to 2% of max health every 3 seconds. |
| 9 | 
|
Bosses start at tier 2. | On Worlds 6 and 7, bosses will be at tier 5. |
| 10 | 
|
Lose 60% of your  Shield when you Shuffle.
|
 Duct Tape and  Transcendence reduces shield loss by 15%.
|
| 11 | 
|
Evil Hostages can appear. | Evil medics with 250 base HP can appear in zones alongside regular Hostages. In Distress Call zones, they can replace them entirely. Their attacks inflict 40 Poison, which ignores Shield. |
| 12 | 
|
Shops cost more. | Price increase is at roughly 15.5%. Does not affect the costs of Upgrades, Removals or shop restocks |
| 13 | 
|
All Bosses are max tier. | Overwrites Hell Pass 9. Bosses start at tier 4, and on stage 6 and 7, they will cap out at tier 7. |
| 14 | 
|
Start with 1 max HP. | Overwrites Hell Pass 5. Max HP still can be increased through certain artifacts, such as  Soul Food, Pacts, and Spells with L (Flex) upgrades. Shopkeeper can nearly negate the effects of this modifier, as while she'll still start with 1 HP, her starting artifact,  Beret, will allow her max HP to be equivalent to her current Money.
|
Trivia[ | ]
- When a player completes a run on any Hell Pass difficulty for the first time, the icon to the left of that level's logo will have one segment filled in, corresponding to the method by which the run was completed. Completing a Pacifist run for the first time will fill the right segment yellow, a Neutral ending will fill the bottom segment blue, and completing a Genocide run will fill the left segment magenta. These are tracked separately across each Hero, Hero Kit, and Hell Pass difficulty.