MD 23 begins at an intersection with US 1 (Hickory Bypass) in Hickory. The state highway heads west as two-lane undivided East–West Highway, passing south of a park and ride lot serving MTA Maryland commuter buses. MD 23 passes through a commercial area where the highway intersects US 1 Business (Conowingo Road) and Water Tower Way before the road passes through a narrow forested corridor. The state highway intersects Commerce Road at a roundabout; Commerce Road heads north into an industrial park surrounding Forest Hill Airport. After crossing over Bynum Run and the Ma and Pa Trail, a rail trail along the abandoned right-of-way of the Maryland and Pennsylvania Railroad, MD 23 intersects MD 24 (Rocks Road/Rock Spring Road) just south of Forest Hill. MD 23 continues west through a mix of farmland and forest, passing south of the hamlet of Fairview and crossing over Phillips Mill Road and Morse Road before East–West Highway reaches its western terminus at MD 165 (Baldwin Mill Road) south of Jarrettsville.