Screenshots of the purported level, which were created with Adobe Photoshop to show a red-hued portal and demonic enemies lifted from unused game assets, emerged and circulated online.

[2] The hoax was first acknowledged by the Synergistic Software-developed expansion pack Diablo: Hellfire, as a quest which features a non-player character dressed in a cow suit with cow-themed dialogue.

[3] According to Edwards, the developers wanted to include a quest that references the hoax in a tongue-in-cheek manner, with the rationale that the inclusion of content that pandered to fan expectations at the time would generate positive feedback and reviews for Hellfire.

[6] The Hell Bovines are led by a boss enemy known as "The Cow King": defeating it will confer special items as quest reward but disables the red portal, which prevents the player from revisiting the area again within that difficulty mode.

[10] In March 2016, Blizzard released a bonus level that paid homage to Diablo III artist and environmental designer Kevin Kanai Griffith, who had died in 2014.

[14] In May 2023, Blizzard general manager Rod Fergusson publicly denied the existence of the cow level and stated that the developers were working to keep Diablo IV "as grounded as possible".

[15] Players nonetheless hinted at supposed clues found in the game after its June release, such as a mention of the "Oxen Gods" and a cow-shaped map.

[20] The cow level is cited as an influential factor for the Diablo series, with multiple sources drawing attention to its notoriety and origins as one of the most notable hoaxes or in-jokes in video game history.

The PC port of Final Fantasy VII includes a reference which can be encountered by the player if the correct decision is picked during an in-game sequence.