The biwa may be used to accompany various types of narrative, as part of a gagaku (court music) ensemble, or as a solo instrument. Although typically it is used to play short standardized phrases between lines of vocal text, it may be used for longer programmatic pieces depicting battles, storms, or other dramatic events. Performers on the instrument frequently pluck two notes simultaneously, producing a variety of intervals, especially when the singer is silent.

The biwa is related to the Chinese pipa, an instrument that was introduced to Japan in the late 7th century. Over the centuries, several types of biwa were created, each having a certain size plectrum, a specialized purpose, a unique performance technique, and varying numbers of strings and frets. Among the major variants are the gakubiwa (used in court music), the mōsōbiwa (used by Buddhist monks for the chanting of sutras), the heikebiwa (used to chant stories from the Heike monogatori), the chikuzenbiwa (used for an amalgam of narrative types), and the satsumabiwa (used for samurai narratives).