The Soprano sax is mainly used as a solo and chamber instrument in classical music, though it is occasionally used in a concert band or orchestra. It is included in the saxophone quartet and plays a lead role. Many solo pieces have been written for it by composers such as Heitor Villa-Lobos.

As an orchestral instrument, it has been used in several compositions. It was used by Richard Strauss in his Sinfonia Domestica, where included in the music are parts for four saxophones, including a Soprano sax in C. It is also used in Maurice Ravel's " Boléro" and has a featured solo directly following the tenor saxophone's solo. Vincent d'Indy includes a soprano in his opera Fervaal.
Due to its ability to sound similar to the oboe, the Soprano sax is sometimes confused with it by listeners. However, the Soprano sax is also sometimes used as a substitute for it when an oboe is not available.
The Soprano sax is also sometimes confused with the B♭ clarinet. The clarinet has a distinctly different timbre, is usually significantly quieter, and can play an augmented fourth lower and is commonly played as much as a fifth higher (though the Soprano sax can also be played this high with altissimo, it is uncommon for a player to do so). Additionally, the saxophone is made of brass and is either lacquered or plated with silver, gold, or occasionally black nickel; while the clarinet is either black or distinctly wood-grained, with silver or gold keys.
Soprano sax mouthpieces are available in various designs, allowing players to tailor their tone as desired.