Over the past ten years, interest in game-based learning has increased. This increase stems from the results of research that demonstrate the potential for increased mathematical learning and engagement when game-based learning was implemented. It has been noted that the most frequent way game-based learning is included in research is with drill and practice problems. There are other ways to implement game-based learning that have the potential to develop conceptual mathematical understanding. This article reviews research on game-based learning in the past decade to categorize the different ways game-based learning is being implemented. Articles focused on middle school mathematics game-based learning were reviewed including Science, Technology, Engineering, and Mathematics (STEM) education game-based learning with a focus on mathematics. Considerations for future implementation and research with game-based learning are discussed.