Police said the bus was carrying 49 passengers when it tumbled down a steep 70-metre (200-foot) slope in the Genting Highlands, which is famed for a flashy gambling and entertainment resort about an hour's drive from the capital Kuala Lumpur.
"We have 20 confirmed dead," a local fire department official, M Mahendran, told AFP by phone.
But a top national fire official was quoted by Malaysian media as saying that observations by rescuers indicated up to 32 may have died.
Reports said most of the passengers were Malaysians, but staff at Hospital Kuala Lumpur said the injured brought in from the crash included a Thai man and a Bangladeshi man.
Local hospitals said several of the injured arrived in critical condition.
Lines of rescuers clinging to an orange rope for support were seen pulling injured victims out of the bus, which was lying on its side in thick vegetation.
Amateur photos posted on the Internet also showed damage to the road's concrete embankment, suggesting the bus had smashed through the barrier.
Police said the bus was part of a regular line that ferries visitors between the capital and the hill resort.
The resort, whose bright lights can be seen from the city at night, is operated by Malaysian gaming firm Genting, one of the country's largest companies.
Genting Highlands includes the country's sole casino and attracts more than 20 million visitors per year.
It is currently undergoing a reportedly three billion ringgit ($900 million) refurbishment that includes a Twentieth Century Fox theme park set to open in 2016.
The road leading up the Genting Highlands is notoriously steep and winding.
Two Indian tourists died and 22 other people were hurt when their bus overturned in the area last year.
The country's deadliest road transport tragedy was a bus accident in 2010 in the Cameron Highlands, another hill resort area.
That accident killed 27.
Muslim-majority Malaysia has banned gambling but allows non-Muslims to bet at the casino in the Genting Highlands, as well as on horse-racing and private lotteries.
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