The currently operational 433-kilometre (269-mile) segment of the expressway runs through Karak, Pahang and Kuala Nerus, Terengganu.

The East Coast Expressway begins from the eastern end of the Kuala Lumpur–Karak Expressway at Karak, Pahang, then runs through Lanchang, Mentakab, Temerloh, Chenor, Maran, Sri Jaya, Gambang, Kuantan, Jabur, Cheneh, Chukai, Kijal, Kerteh, Paka, Dungun, Bukit Besi, Ajil and Telemong, ending in Kampung Gemuruh near Kuala Nerus in Terengganu.

Due to the very high cost, MTD Group and MRCB withdrew from the consortium, leaving Pelita to do the job alone.

A letter of intention was sent by the federal government to MTD Group on 1 March 2000, and the new concession contract was signed on 17 January 2001.

[4] MTD Group was chosen as the new concessionaire company for being able to offer the lowest construction cost for the expressway project.

[2] The construction of the East Coast Expressway began in October 2000 through MTD Capital Sdn Bhd using acquired land costing RM29.2 billion.

The East Coast Expressway Phase 1 from Karak to Kuantan was opened to motorists on 1 August 2004, with the total cost of RM1.3 billion, which was translated to RM7.5 million per kilometre.

The construction of the second phase of the East Coast Expressway E8 began in 2006 as a result of the Barisan Nasional takeover of Terengganu state government from PAS during the 2004 general election.

[23][24] The operation of the toll plazas along the ECE2 E8 is conducted temporarily by Malaysian Highway Authority (LLM) themselves before being handed to PLUS Malaysia Berhad in August 2015.

[24] The length of this segment is 174 km (108 mi) and runs from Kuala Lumpur–Karak Expressway through Lanchang, Mentakab, Temerloh, Chenor, Maran, Kuantan and ends at the Pahang–Terengganu border near Jabur.

Motorists are required to sign-in using Touch 'n Go cards or SmartTAG (transit tickets for cash transactions are no longer accepted starting August 2017).

Motorists which leave the expressway sign out at the desired toll plaza and will be charged according to distance and type of vehicle.

The first phase of the expressway ends at Jabur, at the Pahang–Terengganu border, which also serves as the Limit of Maintenance Responsibility for ANIH Berhad.

Fully operational by January 2015, the second phase of the ECE begins in Jabur, crossing Cheneh, Chukai, Kijal, Kerteh, Paka, Dungun, Bukit Besi, Ajil, and Telemong before terminating at an interchange with Highway 3 at Kampung Gemuruh near Kuala Terengganu.

LPT2 is almost parallel to Highway 14, save for the stretch between Kijal and Bukit Besi, where the expressway veered closer to the coast.

Pending the finalization of the concession agreement, the toll fare was calculated until Jabor for the time being, effectively making the Jabor–Kuala Terengganu stretch free of charge.

The Terengganu state government had reportedly requested that toll collection be postponed until after the 2016 Hari Raya celebrations in July 2016.

[28] Phase 3 will connect from Kampung Gemuruh (near Kuala Terengganu) to Kota Bharu and Tumpat, just before the border with Thailand.

The majority of accidents and fatalities on the new stretches of the expressway was attributed to reckless or exhausted drivers, trespassing animals and damaged and water-logged roads.

[30] Unlike the Kuala Lumpur - Karak Highway of E8 section, East Coast Expressway uses closed toll system with barriers where tolls are built on most of their access points and rates are calculated based on distance travelled between the entry and exit point.

The current terminus of this system lies on Karak toll plaza westbound and Kuala Terengganu eastbound.