In the context of China’s carbon peaking and carbon neutrality goals, clarifying whether the Yellow River Basin can achieve a decoupling of economic growth from carbon emissions and sustain regional development through deep decarbonization is critical to both ecological protection and high-quality development of the region. This study integrates the Tapio decoupling model, the geographically and temporally weighted regression (GTWR) model, and an author-developed LEAP-YRB v5 macro-sectoral hybrid model to examine 95 prefecture-level cities from 2010 to 2022 and to project energy consumption and carbon emissions for the nine YRB provincial-level regions from 2022 to 2060. The results show that: (1) the urban decoupling status fluctuated among expansive coupling, strong decoupling, and weak decoupling, with weak decoupling becoming dominant and increasing to 62 cities in 2022; (2) per capita GDP and urbanization tended to increase the decoupling index and therefore inhibited decoupling, whereas more intensive construction-land use promoted decoupling, and industrial structure upgrading and green patents showed context-dependent effects; and (3) the basin cannot peak its emissions under the business-as-usual scenario, while the policy-driven scenario peaks at approximately 3.357 billion tons of CO₂ around 2030. Under the carbon-neutrality-oriented scenario, net emissions decline substantially to 825 million tons by 2060, indicating deep decarbonization but not full carbon neutrality. Full neutrality would require additional carbon sinks, cross-regional clean-electricity integration, stronger power-sector decarbonization, or negative-emission technologies beyond the endogenous measures represented in the model.