1. Aetna considers the following tests experimental and investigational because the Center for Medicare & Medicaid Services (CMS) and have determined that these diagnostic tests are obsolete or unreliable, and have been replaced by more advanced procedures:

   • Amylase, blood isoenzymes, electrophoretic
   • Bendien's test for cancer and tuberculosis
   • Bolen's test for cancer
   • Calcium saturation clotting time
   • Calcium, feces, 24-hour quantitative
   • Capillary fragility test (Rumpel-Leede)
   • Cephalin flocculation
   • Chromium, blood
   • Chymotrypsin, duodenal content
   • Circulation time, one test
   • Colloidal gold
   • Congo red, blood
   • Gastric analysis, pepsin
   • Gastric analysis, tubeless
   • Guanase, blood
   • Hormones, adrenocorticotropin quantitative animal tests
   • Hormones, adrenocorticotropin quantitative bioassay
   • Rehfuss test for gastric acidity
   • Serum glutamate dehydrogenase 
   • Serum seromucoid assay for cancer and other diseases.
   • Skin test, actinomycosis
   • Skin test, brucellosis
   • Skin test, cat scratch fever
   • Skin test, lymphopathia venerum
   • Skin test, psittacosis
   • Skin test, trichinosis
   • Starch, feces, screening
   • Thymol turbidity, blood

   • Zinc sulphate turbidity, blood.

2. Aetna considers the following procedures experimental and investigational because they are obsolete:

   • Displacement therapy (Proetz type)
   • Heart catheterization by left ventricular puncture
   • Contrast or chain urethrocystography
   • Incisional biopsy of the prostate
   • Cystotomy or cystostomy, with cryosurgery, fulguration and/or insertion of radioactive material
   • Cystourethroscopy with insertion of radioactive substance
   • Prostatotomy for external drainage of prostate abscess
   • Open biopsy or excision of internal mammary nodes.

This policy includes tests and procedures that have been deemed obsolete by the Centers for Medicare & Medicaid Services, McKesson Corporation ClaimCheck and other authorities. Obsolete tests and procedures are those that are outdated and are no longer standard of care.

Transrectal ultrasound-guided core needle biopsy has replaced incisional biopsy of the prostate for diagnosis of prostate cancer. In the core needle biopsy procedure, a needle is inserted into the wall of the rectum into the prostate gland and a core sample is removed for pathological analysis. Alternatively, the needle may be inserted through the perineum to the prostate gland. Typically, about a dozen cores of the prostate are taken.

Prostate abscesses may occur as a complication of prostatitis. Treatment involves appropriate antibiotics and drainage. Transurethral evacuation or transperineal aspiration have replaced a prostatotomy as the standard method of drainage of a prostatic abscess. 

For many years, contrast or chain urethrocystography was used to evaluate the lower urinary tract. This procedure has been replaced by ultrasonography for imaging of the urethrovesical anatomy due to the radiation exposure from contrast or chain urethrocystography and due to the less invasive nature of ultrasonography.

Heart catheterization by left ventricular puncture has been made obsolete by catheterization through the femoral artery or through an upper extremity artery using percutaneous access methods. Right heart catheterization now is commonly performed from the femoral, internal jugular, or subclavian veins.

Cystourethroscopy has replaced cystotomy or cystostomy for cryosurgery or fulguration of bladder lesions. Although cystourethroscopy can be used to deliver radioactive substances to the bladder (intravesical brachytherapy), current evidence-based guidelines do not recommend brachytherapy as an established treatment for bladder cancer.

The lymphatic drainage pathways of the breast (axillary, internal mammary, and supraclavicular nodal groups) are the regional areas most likely to be involved with metastatic breast cancer. The axillary lymph nodes receive 85 percent of the lymphatic drainage from all quadrants of the breast; the remainder drains to the internal mammary chain.  Internal mammary metastases had been thought to be associated with a grave prognosis. However, their significance appears to be no different from axillary lymph node involvement, although the prognosis is worse when both nodal groups are involved. Routine dissection of internal mammary nodes does not improve long-term overall survival, and is not routinely performed. As a result, a multinational conference on sentinel lymph node biopsy in breast cancer failed to reach a group consensus on the need for internal mammary nodal dissection in women with detection of an internal mammary sentinel lymph node (Schwartz, et al., 2002). 

The standard method of sinus irrigation in sinusitis involves placement of an instrument into the sinus and flushing the sinus with sterile water.  This procedure is typically performed with local anesthesia (i.e., novocaine). The Proetz procedure (saline irrigation combined with suctioning) is an older method of sinus irrigation. With the patient in the supine position and the head hyperextended, the nose and nasopharynx are partially filled with a saline solution to which a topical decongestant may be added. Suction is then applied to one nostril while the other is occluded in order to remove the irrigating solution along with the secretions. These steps may be repeated in order to achieve irrigation and drainage of the sinuses. The effectiveness of this procedure in improving clinical outcomes of sinusitis and its advantages over the current standard method of sinus irrigation are not well documented in the peer-reviewed published medical literature.