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During spring training in 2019, Gausman dealt with a sore shoulder. He began the season rehabilitating in the minor leagues, and made his season debut on April 5. On May 3, 2019, Gausman was ejected from a game against the Miami Marlins by umpire Jeff Nelson for throwing behind José Ureña. He and Ureña had last faced each other on August 15, 2018, when Ureña hit the Braves' Ronald Acuña, with a pitch. Major League Baseball fined and suspended Gausman for five games after he threw at Ureña. Gausman appealed the suspension. On May 12, Gausman dropped his appeal of the penalty. In 16 starts, he was 3-7 with a 6.19 ERA.

On August 5, 2019, the Cincinnati Reds claimed Gausman off waivers from the Braves. With the Reds, Gausman became a reliever. In a relief appearance against the St. Louis Cardinals on August 18, Gausman pitched his second career immaculate inning, while striking out all six batters he faced. Gausman was non-tendered on December 2, 2019, and became a free agent.

On December 10, 2019, Gausman signed a one-year contract with the San Francisco Giants.

Before the 2018 season, Gausman changed from his old number of 39 to 34, in honor of the late former Toronto Blue Jays and Philadelphia Phillies pitcher Roy Halladay. On April 23, in a start against the Cleveland Indians, Gausman threw the 90th immaculate inning in MLB history, striking out three batters in one inning on just nine pitches.

On July 31, 2018, Gausman along with Darren O'Day, was traded to the Atlanta Braves in exchange for minor leaguers Brett Cumberland, Jean Carlos Encarnacion, Evan Phillips, Bruce Zimmermann, and international signing money.

On March 28, 2017, Gausman was named the Orioles' Opening Day starting pitcher for the first time in his career. He pitched 5.1 innings on Opening Day, allowing two runs on five hits and four walks, while also striking out four batters. Gausman earned the no decision. On May 3, Gausman was ejected for the first time in his Major League career after hitting Xander Bogaerts with a pitch. On July 29, Gausman pitched the longest outing of his career against the Texas Rangers, going 8​⁄3 shutout innings while striking out eight batters and earning the victory.

Gausman married in December 2016, and has a daughter.

Gausman made 25 appearances in 2015 (17 starts). He posted a moderate 4.25 ERA, but struck out a career-high 103 batters, averaging 8.3 K/9. He posted a 4–7 record, as the Orioles finished 81–81 and didn't make the playoffs.

On June 7, 2014, Gausman earned his first win as a starting pitcher, going seven innings against the Oakland Athletics, allowing only one run, walking one, and striking out six. Following the best outing of his young career, Gausman pitched against the AL East leading Toronto Blue Jays where he went six innings, again allowing one run and striking out three. In the 2014 postseason, Gausman pitched out of the bullpen for the Orioles. Gausman pitched eight innings in three relief appearances, posting a 1.13 ERA and an 0.75 WHIP. The Orioles would sweep the Tigers in the ALDS before being swept in the ALCS by the Kansas City Royals.

Gausman finished the 2014 campaign having made 20 starts, with one complete game (five innings, due to rain), posting a 3.57 ERA and a 7–7 win/loss record.

Gausman started the 2013 season with the Double-A Bowie Baysox until the Orioles promoted him to the major leagues to make his debut in Toronto against the Blue Jays on May 23, 2013. In his debut against the Blue Jays, Gausman pitched five innings and allowed seven hits, four runs, and two walks, also adding five strikeouts. Gausman picked up the loss as the Orioles fell 12-6 to the Blue Jays. On June 14, Gausman was optioned to the Triple-A Norfolk Tides. He was recalled on June 24. On June 28, Gausman earned his first Major League win, against the New York Yankees, pitching in relief of T. J. McFarland, going 4 1/3 innings, striking out four and allowing no walks and three hits. He was optioned back to Norfolk on July 10. He was again recalled from the Norfolk Tides on August 28, and earned his second big league win on September 1, also against the Yankees, but at Yankee Stadium.

Gausman throws five pitches, all with above average velocity: a four seam fastball at 96–99 miles per hour (154–159 km/h) (tops out at 101 miles per hour (163 km/h)), a sinker at 93–96 miles per hour (150–154 km/h), a slider at 83–86 miles per hour (134–138 km/h), a splitter at 84–86 miles per hour (135–138 km/h), and a changeup at 84–89 miles per hour (135–143 km/h).

Gausman was drafted by the Baltimore Orioles fourth overall in the 2012 MLB Draft. He was an All-American in 2012 at LSU. He signed with the Orioles for $4.32 million on July 13, 2012.

Gausman attended Grandview High School in Centennial, Colorado, where he played for the school's baseball team as a pitcher. In 2010, his senior year, he was 9-2 with a 3.12 ERA.

The Los Angeles Dodgers selected Gausman in the sixth round of the 2010 Major League Baseball Draft, but he did not sign. He attended Louisiana State University (LSU), where he played college baseball for the LSU Tigers baseball team. In 2011, he played collegiate summer baseball with the Harwich Mariners of the Cape Cod Baseball League. In 2012, as a sophomore at LSU, he was 12-2 with a 2.77 ERA in 18 games (17 starts).

Kevin John Gausman (born January 6, 1991) is an American professional baseball pitcher for the San Francisco Giants of Major League Baseball (MLB). He previously played in MLB for the Baltimore Orioles, Atlanta Braves, and Cincinnati Reds. Before his professional career, Gausman attended Louisiana State University (LSU) and played college baseball for the LSU Tigers. The Orioles selected him in the first round (4th overall) of the 2012 MLB draft. He made his MLB debut in 2013.