The Ballad of Billy Balls is structured as a single season-long investigation rather than a case-of-the-week anthology. Host iO Tillett Wright (rendered in episode transcripts as Ayo Tillett-Wright) narrates the search into what happened to Billy Heitzman, shot in an East Village storefront apartment in 1982 while dating her mother, Rebecca. Crimetown producer Austin Mitchell works alongside Wright throughout, at points conducting interviews directly, such as with Billy's daughter Amanda, when Wright is unavailable. Episodes combine on-the-record interviews with people who knew Billy, including friend Gita Gash and daughter Amanda, with archival and records research, and scenes of the host confronting family members with new information. Recurring subject matter includes the 1970s downtown New York punk and music scene, heroin and methamphetamine addiction, domestic violence, and child neglect. The investigation also follows practical threads, such as tracing Billy's unmarked grave to Hart Island and reconciling conflicting accounts of his death, including an alleged undercover police shooting. A bonus behind-the-scenes episode shows the show's own production process, including last-minute editorial calls by creators Mark Smerling and Zac Stuart-Pontier and a near-missed music placement for the series' theme song. The show is produced by Crimetown/ZSP Media with Cadence 13 and iHeartPodcasts. Listeners drawn to memoir-inflected true crime, family secrets, and downtown New York music history in the 1970s-80s are the core audience. The feed also includes trailers for unrelated true-crime series from the same producers, such as The Confessions of Anthony Raimondi and Beyond All Repair, which are cross-promotional inserts rather than part of the Billy Balls narrative.