High-pressure gas pipelines are significantly vulnerable to earthquake-related geohazards (tectonic faulting, slope instabilities, and/or soil liquefaction phenomena). Avoiding geohazardous areas is not always techno-economically feasible, as it would increase the length and cost of the infrastructure. Conversely, crossing these areas may adversely affect the structural performance of the pipeline, leading to unfeasible mitigation measures. Thus, selecting cost-effective, safe, and resilient routing is crucial. This study presents a GIS-based decision-support tool for optimal routing, taking into account, among other criteria, earthquake-related geohazards. The proposed tool considers not only the aforementioned but also more complex earthquake-related geohazards, such as secondary fault ruptures that are non-parallel or even perpendicular to the main fault, which might have been overlooked during the design of existing pipelines. To validate its effectiveness, the present tool is applied in a real case study in northern Greece, where the aforementioned earthquake-related geohazards coexist. Through a GIS-based multi-criteria decision method, various scenarios are examined by assigning different weights to the adopted criteria, and several cost-minimized routes are derived. This tool could be highly beneficial for the pipeline industry since it can assist operators and stakeholders in selecting the optimal pipeline route in geohazardous areas.