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The highway begins at Missouri Route 43.
When it reaches Missouri Route 59, it has a brief concurrency and the road passes under the bluffs.
At Noel, the highway leaves the duplex and continues east.
Halfway between the City of Noel and US 71 is a planned interchange with future I-49.
Further east, the highway intersects the current US 71.
At Jane, Route 90 crosses an older alignment of U. S. Route 71.
About fifteen miles ( 24 km ) west of its terminus is an intersection with Route E, in which the primary highway ( Route 90 ) stops for a secondary road ( Route E ), a very rare and possibly unique occurrence in the state.
The route ends at Missouri State Route 37 in Washburn, MO.

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