Metabolic dysfunction-associated steatohepatitis (MASH) with compensated cirrhosis is associated with poor prognosis due to a high risk of hepatic decompensation, hepatocellular carcinoma, cardiovascular events, and death. Using noninvasive diagnostic tools like FIB-4, VCTE, and Agile 4, clinicians can accurately identify cirrhosis and clinically significant portal hypertension without the need for biopsy. Management focuses on preventing hepatic decompensation through beta-blocker therapy (particularly carvedilol), nutritional optimization, and hepatocellular carcinoma surveillance. Novel therapies such as efruxifermin and resmetirom may reverse fibrosis. This evidence-driven approach aims to improve outcomes in patients with MASH-related compensated cirrhosis.