Although several problems related to biofouling of marine current turbines (MCTs) are reported in the literature, the most important one is related to long-term operational performance and maintenance costs. Nevertheless, studies related to the impact of biofouling on MCT performance are rather scarce. In this study, the impact of biofilm on MCT performance is investigated using the Computational Fluid Dynamics (CFD) approach. Biofilm is modelled using previously developed roughness functions implemented in a wall function solver. A verification study is performed to determine sufficient grid spacings and to calculate numerical uncertainty. The validation study is conducted by comparing the obtained results with experimental and numerical ones from the literature. Full-scale CFD simulations are performed for six fouling conditions with varying biofilm height and percentage of surface coverage at eight tip speed ratios (TSRs). The obtained results highlight the significant impact of biofilm on MCT performance reflected in a decrease in the power coefficient, which for the optimal TSR is equal to −10.7% for the R1 fouling condition. Finally, a detailed analysis of the flow around MCTs fouled with biofilm is conducted and the reasons for the detrimental impact of biofilm on MCT performance are discussed.