Coming off their win over the Bengals, the Bills went home, donned their throwbacks, and played a Week 13 intraconference duel with the Pittsburgh Steelers.  Buffalo trailed early in the first quarter as Steelers running back Rashard Mendenhall got a 1-yard touchdown run.  Pittsburgh added onto their lead in the second quarter with kicker Shaun Suisham getting a 45-yard and a 46-yard field goal. The Bills answered in the third quarter as quarterback Ryan Fitzpatrick found running back Fred Jackson on a 65-yard touchdown reception.  Buffalo would tie the game in the fourth quarter with a 29-yard and a 32-yard field goal from kicker Rian Lindell.  The Steelers would regain the lead as Suisham made a 48-yard field goal, yet the Bills tied the game again with Lindell's 49-yard field goal. Wide Receiver Stevie Johnson dropped what would have been a 40-yard, game-ending touchdown pass in overtime. However, Pittsburgh got the last laugh in overtime as Suisham booted the game-winning 41-yard field goal. With the loss, the Bills fell to 2-9 and were eliminated from postseason contention.

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