PTH 23 begins in the Rural Municipality of Grassland at an intersection with PTH 21 roughly 3 kilometres (1.9 mi) south of Hartney, just southeast of the remains of the former Hartney Airport. The highway heads due east for several kilometers, crossing several creeks to pass through the town of Elgin along Main Street, having an intersection with PR 448 here. As it leaves Elgin, it has a junction with PTH 22 on the north side of Whitewater Recreation Park, before heading east through farmland for the next several kilometers, passing just north of Fairfax (where it has an intersection with PR 444) to come to an intersection and become concurrent (overlap) with PTH 10 (John Bracken Highway) for the next several kilometers. PTH 23 follows PTH 10 south to Minto, where it splits off and heads due east again to enter the Rural Municipality of Prairie Lakes.

PTH 23 travels along the southern edges of Margaret, where it crosses PR 346, and Dunrea as it meanders its way into the town of Ninette and becoming concurrent with PTH 18. The pair pass through neighborhoods along the shores of Pelican Lake before making a sharp onto Queen Street and traveling through the center of downtown, where PTH 23 splits off and heads east along the narrow isthmus separating Pelican Lake from the smaller Grass Lake. PTH 23 leaves Ninette and travels along the southern edge of Belmont, passing through several switchbacks along the way, where it has a junction with PR 458 before crossing into the Rural Municipality of Argyle.^[2]

PTH 23 almost immediately has an intersection with PTH 5 (Parks Route) as it heads to pass through the town of Baldur. The highway then goes through a switchback and has a junction with PR 342 at the community of Greenway before crossing into the Rural Municipality of Lorne. PTH 23 goes through several sharp curves for the several kilometers, passing along the eastern edge of Mariapolis and having junctions with PR 440 and PR 532. The highway now travels through the Swan Lake First Nation, where it has an intersection with PTH 34, before passing along the southern edge of the town of Swan Lake. PTH 23 passes by several small lakes as it passes by the communities of Somerset, where it crosses PR 242, St. Leon, crossing PR 244, and Altamont before crossing into the Rural Municipality of Thompson at Deerwood.

PTH 23 goes through a switchback before having a concurrency with PR 240 as it travels past Alexander Ridge Park. Passing through the town of Miami, it has an intersection with PR 338 on its way to travel through Rosebank, having an intersection with PR 432 here and crossing into the Rural Municipality of Roland. The highway crosses a creek several times as it has an intersection with PTH 3 and passes through the village of Roland. Having an intersection with PR 428, it continues east for a few kilometers to pass by Myrtle before having an intersection with PR 306 and entering the Rural Municipality of Morris at Kane.

PTH 23 junctions with PR 336 and PR 332 as it passes through Lowe Farm to enter the town of Morris. The highway follows Boyne Avenue as it crosses a couple of railroad tracks to pass through neighborhoods and enter downtown, where it becomes concurrent with PTH 75 (Lord Selkirk Highway / Main Street). They head south through a business district, where PTH 23 splits off along Montreal Avenue to pass through neighborhoods and cross a bridge over the Red River. PTH 23 goes through a switchback back as it leaves Morris and follows along the border of the Rural Municipality of Montcalm for the next several kilometers, where it has an intersection with PR 246, before crossing into the Rural Municipality of De Salaberry. The highway almost immediately crosses PR 200 and continues due east for the next several kilometers to pass through Dufrost, crossing a railroad line. After a few more kilometers, it crosses a creek before PTH 23 comes to an end at a junction with PTH 59.^[3][4][5]

With the exclusion of the concurrency with PTH 75 in Morris, which is a four-lane boulevard, the entire length of PTH 23 is a rural, paved, two-lane highway.

The original PTH 23 went from Deloraine to Melita. This became part of PTH 3 in 1929.

PTH 23 was designated to its current route in 1950.^[6]

When the current route was first added, the highway's western terminus was at PTH 10 near Minto, with the eastern terminus located at PTH 75 in Morris. The highway's eastern terminus was extended to its current location in 1952,^[7] and to its current western terminus the following year.^[8]

• Manitoba Official Map - Southwest
• Manitoba Official Map - South Central